Long Terme Results of Mitral Valve Repair

Background and aim of the study: Mitral valve repair is the procedure of choice for severe degenerative mitral regurgitation (MR). The objective of this study was to review prospectively gathered echocardiographic and clinical results with mitral valve repair for degenerative disease. Methods: Between May 1995 and July 2004, 403 patients underwent mitral valve repair for degenerative disease (mean age 63 ± 12 years, 72% males). Concomitant procedures included CABG (29%), radiofrequency left-sided maze procedure (8%), aortic valve replacement (6%), and tricuspid valve repair (4%). Results: Thirty-day mortality was 0.4% for patients with isolated mitral valve repair and 5.1% for patients with mitral valve repair and concomitant procedure (p = 0.003). Five-year survival was higher for isolated mitral valve repair compared to mitral valve repair with a combined procedure (92 ± 2% vs. 76 ± 5%; p < 0.001). Pulmonary artery pressure and left atrial and left ventricular end-diastolic diameters were significantly improved following mitral valve repair (all p ≤ 0.005) and this was sustained afterward. The freedom from severe (3+ or 4+) and moderate-severe (2+, 3+, or 4+) MR was 95% and 77% at 5 years, respectively, whereas the freedom from reoperation was 96 ± 1% at 5 years. Significant predictors of moderate-severe MR recurrence were cardiac dilatation, anterior leaflet prolapse, and concomitant procedure, whereas mitral valve disease amenable to posterior leaflet resection had a lower risk of MR recurrence. Conclusions: Excellent clinical outcomes can be obtained using standard techniques of mitral valve repair of the degenerative valve. MR recurrence is low but nonnegligible, emphasizing the necessity for long-term postoperative echocardiographic follow-up in these patients. doi: 10.1111/j.1540-8191.2009.00897.x (J Card Surg 2010;25:9-15) Degenerative disease is the leading cause of mitral regurgitation (MR) in North America. Advantages of mitral valve repair over replacement include lower operative mortality, better preservation of ventricular function, lower risk of thromboembolism and anticoagulantrelated complications, reduced risk of endocarditis, and better freedom from valve-related complications with an excellent long-term durability.1-5 This work was supported by the Michael and Renata Hornstein Chair in Cardiac Surgery, Université de Montréal, Montreal, Quebec. Salary support (to LMS) was provided by a fellowship award from the Canadian Institutes of Health Research’s Clinical Research Initiative, Ottawa, Ontario. Paper presented as poster: Clinical and Echocardiographic Results of Mitral Valve Repair for Degenerative Disease [Résultats cliniques et échocardiographiques à long terme pour la réparation de la valve mitrale dégénérative] at the 59th Meeting of the Société Française de Chirurgie Thoracique et Cardio-Vasculaire, 2006, Bordeaux, France. Address for correspondence: Michel Pellerin, M.D., Department of Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada. Fax: +514-376-1355; e-mail: [email protected] Although many studies have reported outcomes of mitral valve repair in terms of survival and freedom from reoperation,1-5 few studies have assessed longterm echocardiographic results of these patients.6-10 Moreover, this study is the first to report postoperative changes in left atrial and left ventricular dimensions, pulmonary artery pressure, and left ventricular ejection fraction (LVEF) for this patient population. The purpose of this paper is to review prospectively gathered echocardiographic and clinical results following mitral valve repair for degenerative disease and assess patient characteristics and operative technique predicting these outcomes. MATERIAL AND METHODS From May 1995 to July 2004, 403 consecutive patients underwent mitral valve repair for degenerative disease. Intraoperative transesophageal echocardiography was used to assess mitral valve repair in all patients. Patients were followed prospectively at the Montreal Heart Institute Valve Clinic on a yearly or 2-year basis. Patients were considered lost to follow-up 403 MVR for dystrophic disease J CARD SURG 2010;25:9-15 STEVENS, ET AL. MITRAL VALVE REPAIR OUTCOMES 13 Figure 2. Fre dom from dyspnea following mitral valve repair (Turnbull’s algorithm). Freedom from dyspnea for patients undergoing mitral valve repair for degenerative disease. Turnbull’s nonparametric estimates for freedom from moderatesevere dyspnea (NYHA II, III, or IV) and freedom from severe dyspnea (NYHA III or IV) are represented with step functions. Weibull’s pa metric estimate is shown with an overlying dashed line. Numbers at risk are provided in the embedded table. NYHA = New York Heart Association. antiplatelet medication. The major indication for anticoagulation was atrial fibrillation. Freedom from bleeding and thromboembolic events was 94 ± 2% at 5 years.