Long-Term Results of Mitral Valve Repair

Abstract

IntroductionCurrent guidelines state that patients with severe mitral regurgitation should be treated in reference centers with a high reparability rate, low mortality rate, and durable results.ObjectiveTo analyze our global experience with the treatment of organic mitral regurgitation from various etiologies operated in a single center.MethodsWe evaluated all surgically treated patients with organic mitral regurgitation from 2004-2017. Patients were evaluated clinically and by echocardiography every year. We determined early and late survival rates, valve related events and freedom from recurrent mitral regurgitation and tricuspid regurgitation. Valve failure was defined as any mitral regurgitation ≥ moderate degree or the need for reoperation for any reason.ResultsOut of 133 patients with organic mitral regurgitation, 125 (93.9%) were submitted to valve repair. Mean age was 57±15 years and 52 patients were males. The most common etiologies were degenerative disease (73 patients) and rheumatic disease (34 patients). Early mortality was 2.4% and late survival was 84.3% at 10 years, which are similar to the age- and gender-matched general population. Only two patients developed severe mitral regurgitation, and both were reoperated (95.6% at 10 years). Freedom from mitral valve failure was 84.5% at 10 years, with no difference between degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid regurgitation was present in 34% of the patients, being more common in the rheumatic ones. The use of tricuspid annuloplasty abolished this complication.ConclusionWe have demonstrated that mitral regurgitation due to organic mitral valve disease from various etiologies can be surgically treated with a high repair rate, low early mortality and long-term survival that are comparable to the matched general population. Concomitant treatment of atrial fibrillation and tricuspid valve may be important adjuncts to optimize long-term results.

Interventricular septal diverticulum and rheumatic mitral valve disease identified and managed concurrently in middle age

“…The outcome of severe TR after surgery is unfortunate and puzzling. One might consider the right-sided Cryomaze procedure, with an incision to the posterior aspect of the tricuspid annulus as a possible cause of the newly developed TR, or even the MVR where TR after MVR alone is reported within the literature although usually as a late finding 10. However, the early presentation of severe TR is more likely attributable to the diverticula repair itself; this could either be as consequence of direct damage affecting the integrity of the valve intraoperatively despite meticulous efforts to preserve its function, or as a consequence of aberrant haemodynamics after repair with retained contractile diverticulum tissue within the right ventricle.…”

Participating in Sports After Mitral Valve Repair for Primary Mitral Regurgitation: A Retrospective Cohort Study

“…Mitral valve (MV) repair is a well-established treatment method for primary MR with an excellent long-term clinical outcome and durability of MV functionality. 2,3 These results have led the European and American Societies of Cardiology to extend the indication of MVR to asymptomatic patients with low surgical risks, preserved LV function, and early dilatation. [13][14][15] In this cohort, asymptomatic patients represent a significant proportion with 21% of the indications.…”

“…1 Surgical mitral valve repair (MVR) is known to be the gold standard therapy in primary MR and provides excellent long-term results with a mortality rate similar to the general population. 2,3 When feasible, conservative mitral surgery is increasingly proposed to young patients with severe MR, who sometimes have few or no symptoms. 4 Many of these patients used to participate in leisure or competitive sports before surgery.…”

Long term outcome of valve repair for degenerative mitral valve disease in Iceland

“…37 Langtímalifun sjúklinga eftir aðgerð reyndist mjög góð en 5 ára lifun var 93,5% og 10 ára lifun 85,3% sem er í takt við erlendar rannsóknir. 27,38,39 MACCE-frí lifun var einnig mjög góð, eða 91,1% og 81,1% fyrir sömu tímabil, sem er mun haerra en sést hefur eftir kransaeðahjáveituaðgerðir hér á landi (80,3% og 60,1%). 40 Þá var athyglisvert að lífslíkur sjúklinga voru sambaerilegar almennu íslensku þýði af sama kyni og aldri en svipuðum niðurstöðum hefur verið lýst í erlendum rannsóknum.…”