[Mitral surgery: prognostic and survival factors. Value of the French score]

Conservative mitral surgery is the preferred treatment for mitral regurgitation whatever the etiology. Morbidity and mortality figures, both during hospitalization and after long-term follow-up, are better than for mitral valve replacement. This difference could result from a selection bias or express a specific effect of conservative mitral surgery on survival. In addition, concerns about cost-containment justify rigorous analysis of treatment quality. The "French" score can be used for preoperative assessment of individual and population operative risk and for inter-institution comparisons. Its value for assessing overall survival is unknown.

Using the French score, we compared the clinical features and laboratory data in 100 patients who underwent conservative mitral valve surgery and in 35 patients who had valve replacement. We looked for independent factors predicting overall survival.

Overall survival tended to be better after conservative mitral surgery, reaching 86% at 4 years versus 72% after replacement (p = 0.08). The populations were different as the valve replacement group included more women, was more symptomatic (p = 0.022), had heart failure more often (p = 0.003) and tended to have a higher French score (p = 0.06). Inversely, the hemodynamic and echocardiographic parameters were not different between the two groups.

Independent factors predicting late mortality were preoperative heart failure and the French score. The type of mitral surgery did not have any predictive value.

In addition to its value for assessing operative risk, the French score appears to be useful for predicting overall survival after mitral surgery.