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Optimal versus suboptimal mitral valve repair: late results in a matched cohort study

Michele De Bonis1,2, Edoardo Zancanaro2, Elisabetta Lapenna2

  • 1School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 17, 2020
PubMed
Abstract

Insights

Suboptimal mitral repair for degenerative mitral regurgitation (MR) leads to lower durability and increased need for medication. Even optimal repairs do not halt MR progression, highlighting the chronic nature of the condition.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Repair

Background:

  • Degenerative mitral regurgitation (MR) requires repair, with ideal outcomes aiming for no or mild residual MR (≤1+/4+).
  • Occasionally, patients have more than mild residual MR (>1+/4+) after mitral repair due to various factors.
  • Assessing the long-term consequences of suboptimal mitral repair is crucial for patient management.

Purpose of the Study:

  • To evaluate the late implications of mitral repair resulting in more than mild residual MR.
  • To compare outcomes between patients with suboptimal repair and those with optimal repair (≤1+ MR).

Main Methods:

  • A matched cohort study included 50 patients with residual MR >1+ (study group) and 91 patients with MR ≤1+ (control group).
  • Patients underwent mitral repair for degenerative MR between 2006 and 2013.
  • Median follow-up was 8 years, with comparative analysis of survival, reoperation, and MR progression.

Main Results:

  • Overall survival at 8 years was similar between groups (87% ± 8% vs. 92% ± 3%, P=0.23).
  • Freedom from reoperation was also similar (P=1.0).
  • The prevalence of severe MR (≥3+) was significantly higher in the suboptimal repair group (15.6% vs. 2.1%, P<0.001), along with increased medication use. Even optimal repairs showed MR progression over time.

Conclusions:

  • Mitral repair with residual MR >1+ is linked to reduced long-term durability and increased medical therapy needs.
  • Optimal initial mitral repair results do not prevent the progression of degenerative MR.
  • Continuous monitoring and management are essential even after successful mitral valve repair.
Keywords:
Long-term outcomeMitral regurgitationMitral valve repairResidual mitral regurgitation

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