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Early- and Long-Term Outcomes of Mitral Valve Repair in a Low-Volume Centre in the Caribbean

Richard A E Ramsingh1,2, Gianni D Angelini3, Risshi D Rampersad1

  • 1Cardiology Department, Caribbean Heart Care Medcorp, St. Clair Medical Centre, St. Clair, Port of Spain, Trinidad & Tobago.

Brazilian Journal of Cardiovascular Surgery
|July 8, 2021
PubMed

Insights

Mitral valve repair in a low-volume Caribbean center showed good early and long-term outcomes. Despite challenges, the procedure is safe and effective for both functional (FMR) and degenerative (DMR) mitral regurgitation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair
  • Outcomes Research

Background:

  • Mitral valve repair is a complex procedure often associated with high-volume centers.
  • Low-volume centers face unique challenges in maintaining surgical expertise and achieving optimal patient outcomes.

Purpose of the Study:

  • To evaluate the early and long-term results of mitral valve repair in a low-volume cardiac surgery center in the Caribbean.
  • To assess the safety and efficacy of mitral valve repair for functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR).

Main Methods:

  • Retrospective analysis of prospectively collected data from 96 consecutive mitral valve repair patients (April 2009-December 2018).
  • Patients were categorized into FMR (n=63) and DMR (n=33) groups based on repair complexity.
  • Outcomes assessed included 30-day mortality, early and late echocardiographic results, functional status (NYHA class), re-operation rates, and survival.

Main Results:

  • Overall 30-day mortality was 2.1%. FMR group: 83.6% had no or trivial/mild regurgitation early post-op, but long-term functional status declined (42.8% NYHA class I). Survival was 75.6% with 98% freedom from re-operation.
  • DMR group: 97% had no or trivial/mild regurgitation early post-op, with sustained good long-term function (93.3% NYHA class I). Survival was 90.9% with no re-interventions and 96.3% mild or no mitral regurgitation.

Conclusions:

  • Mitral valve repair can be performed safely and effectively in low-volume centers, even with limited resources.
  • Good early and long-term outcomes are achievable for both FMR and DMR, highlighting the importance of dedicated surgical teams.
  • These findings support the feasibility of mitral valve repair in underserved regions, challenging the notion that it's exclusively confined to high-volume institutions.
Abstract

Keywords:
Caribbean RegionData ManagementEchocardiographyMitral Valve AnnuloplastyMitral Valve InsufficiencyReoperation

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