Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation

Abstract

Background: This study investigated the consequences of recurrent mitral regurgitation (MR) after mitral valve (MV) repair in patients with degenerative MR and risk factors for recurrence. Methods and Results:From January 1990 to December 2015, 792 patients underwent MV repair due to degenerative MR. Recurrent MR was defined as moderate-to-severe MR on follow-up echocardiography. Mean follow-up duration was 8.71±5.58 years. During the follow-up period, MR recurred in 133 (16.8%) patients, and the MR recurrence-free rate at 20 years was 77.5±2.0%. In the recurrence group, the degree of MR decreased in 8 (6.0%) patients and was aggravated in 46 (34.6%) patients. Recurrent MR was associated with increased mortality and adverse left ventricular (LV) remodeling. Independent risk factors for MR recurrence were MV repair performed before 2000, preoperative atrial fibrillation, high LV end-diastolic dimension (LVEDD), prolapse of the isolated anterior leaflet or multiple segments, and absence of ring annuloplasty. Predictors of MR progression were high LVEDD and repair without artificial chordae implantation.Conclusions: Recurrent MR after MV repair in patients with degenerative MR showed a tendency to progress and was associated with increased mortality and adverse LV remodeling. Early referral for MV repair before development of atrial fibrillation and LV enlargement may reduce the risk of MR recurrence. Moreover, artificial chordae implantation and ring annuloplasty may assure the long-term durability of MV repair.

Relationship of Surgeon Experience and Outcomes of Surgery for Degenerative Mitral Valve Disease

“…MAC was reported in˜20% of patients undergoing mitral valve surgery 14 and was an independent risk factor for valve replacement 15 . The extent of leaflet prolapse was not a risk factor for recurrence in this cohort, as opposed to previous literature where anterior leaflet and bi-leaflet involvement were associated with increased risk of recurrence [16][17][18] . Of note, these studies included patients who had surgeries decades ago, when the techniques of anterior leaflet repair were not well-established and adopted.…”

Outcomes of mitral valve surgery for severe ischemic mitral regurgitation

“…Despite higher MR recurrence in our study, long‐term survival was similar at 64% at 5 years in each group. In degenerative mitral valve disease, the recurrence of MR after a repair has been shown to correlate with adverse left ventricular remodeling and increased late mortality risk . The reasons why these adverse sequelae of recurrent MR were not observed in our study groups may relate to the follow‐up not being long enough to detect a difference, or, it may relate to the fact that this patient subset has a more limited life expectancy and therefore the deleterious consequences of MR have less of an impact than would be seen in a healthier population.…”

Radiofrequency Ablation Alters the Microstructural Organization of Healthy and Enzymatically Digested Porcine Mitral Valves

“…Myxomatous MV degeneration is a common cause of MR and is often associated with MVP. If left unchecked, patients with persistent MR can have adverse left ventricular remodeling and higher rates of mortality [33]. If detected early, surgical success ratesincluding that of leaflet resection, MV annuloplasty, or edge-to-edge repairare often high with low incidence of mortality [2].…”