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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Extent and Progression of Cardiac Damage in Patients With Primary Mitral Regurgitation Undergoing Surgical Repair

Rinchyenkhand Myagmardorj1, Federico Fortuni1,2, Valentina Mantegazza3

  • 1Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 12, 2026
PubMed
Abstract

Insights

Surgical repair of mitral regurgitation (MR) can improve extra-mitral valve cardiac damage. The evolution of this damage after MR repair predicts mortality, highlighting the need for follow-up echocardiography for risk assessment.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Primary mitral regurgitation (MR) can lead to extra-mitral valve cardiac damage.
  • The progression and prognostic significance of this damage after surgical repair are not well-described.

Purpose of the Study:

  • To investigate the evolution of extra-mitral valve cardiac damage after surgical repair for severe primary MR.
  • To assess the prognostic significance of this cardiac damage evolution on all-cause mortality.

Main Methods:

  • A cohort of 764 patients with severe primary MR undergoing surgical repair were classified based on echocardiographic parameters at baseline and follow-up.
  • Cardiac damage was staged hierarchically (0-3) including left ventricular/atrial changes, atrial fibrillation, and pulmonary hypertension.
  • All-cause mortality was the primary outcome, analyzed using multivariate Cox regression.

Main Results:

  • At a median follow-up of 91 months, 43% of patients showed improvement in cardiac damage stage, 49% remained unchanged, and 8% worsened.
  • Extra-mitral valve cardiac damage staging at follow-up (HR=1.571, p=0.009) and its evolution (improved: HR=0.467, p=0.034; worsened: HR=2.481, p=0.037) were independently associated with all-cause mortality.
  • These factors provided incremental prognostic value over preprocedural assessment.

Conclusions:

  • Extra-mitral valve cardiac damage often improves significantly after mitral valve repair.
  • The evolution of cardiac damage post-repair is a significant independent predictor of all-cause mortality.
  • Comparative echocardiographic assessment following mitral valve repair is crucial for refining risk stratification.
Keywords:
mitral valve annuloplastymitral valve prolapseprimary mitral regurgitation

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