Five-year follow-up of mitral valve repair versus replacement: a propensity score analysis

Abstract

Background Mitral valve repair (MVRe) is considered to have a superior outcome compared to replacement (MVRp) in patients with mitral valve regurgitation (MVR). It was the aim of the study to analyse the clinical results and identify risk factors for short and long-term mortality. Methods In a retrospective single-center analysis, patients undergoing an isolated mitral valve procedure from June 2010 to December 2016 were identified. These were subsequently homogenized using 10 baseline characteristics for propensity-score matching. Comparative analyses were performed for early and long-term results, using adequate statistical tools, and identifying risk factors for the investigated endpoints, primary end-point: all-cause mortality within 5 years and secondary end-points: recurrent MVR, reoperation, endocarditis and/or mortality with 30 days, 1, 3 and 5 years. Results 241 patients were identified in the entire patient cohort. After matching, patients were divided into 2 groups of 64 each respectively. The median age was similar in the two groups. There was a significant interaction between early mortality risk of MV in patients with coronary artery disease (CAD) (OR 11.94, 95% CI 1.49–285.92, p = 0.04) and late mortality in patients with higher EuroSCORE II (HR 1.14, 95% CI 1.06–1.23, p < 0.001). The primary end-point showed 5-year survival rate was significantly higher in MVRe versus MVRp (90.06% vs. 79.54% respectively, p = 0.04). The secondary end-point demonstrated recurrent MVR not to be statistically significant between the 2 groups (p = 0.09) as well as reoperation (p = 0.28). Endocarditis was observed in one patient after MVRp. Conclusions We concluded MVRe to be associated with lower operative and 5-year mortality and good postoperative outcomes compared to patients undergoing MVRp. Concomitant CAD was identified as one of the risk factors for increasing the in-hospital mortality rate. There was no significant difference in rehospitalisation over the follow-up period. MVRe should be the treatment of choice for severe MVR and should remain a central aspect in valve centers' treatment algorithms and quality measures.

Surgical repair and replacement for native mitral valve infective endocarditis

“…Most of these experiences, however, failed to characterise and analyse important factors such as patients' clinical presentation and the extension of the infective process. 2,8,10,11,12 Furthermore, in unmatched studies, mitral replacement cohorts included sicker patients who were older with a higher prevalence of active infection and heart failure and presenting with more severe lesions. 3,19,20 Not surprisingly, valve replacement is still the most common surgery for mitral valve infective endocarditis, as national registries report that mitral repair is performed in approximately 20-30% of the cases.…”

“…There is a general tendency to offer valve repair to younger patients, with better cardiac function, a lower prevalence of severe heart failure, and often in an elective setting. In contrast, mitral valve replacement has been usually performed in acute and urgent cases with a more extensive tissue disruption 2,3,8,10–12 . Propensity-match studies have tried to overcome this limitation, but rarely were able to account for the anatomy and the extent of infective lesions.…”

Surgical intervention for Mitral Stenosis: Temporal changes in patient characteristics, incidence, and mortality: a Danish nationwide cohort study

“…[31][32][33][34][35] These studies have reported long-term mortality rates of 13-22% for patients undergoing mitral valve replacement [31][32][33] and 4-8% for patients undergoing mitral valve repair. [33][34][35] Our nding of allcause mortality seems to be in between the long-term mortality for the two different types of surgical intervention, but closer to the long-term mortality after mitral valve replacement. This matches the distribution of type of surgery, as more patients in our study group underwent mitral valve replacement (75%) than mitral valve repair (25%).…”

“…Few studies have examined death after surgical intervention for MS alone, but multiple studies investigating mortality after surgical intervention for mitral regurgitation and MS have been conducted. [31][32][33][34][35] These studies have reported long-term mortality rates of 13-22% for patients undergoing mitral valve replacement [31][32][33] and 4-8% for patients undergoing mitral valve repair. [33][34][35] Our nding of allcause mortality seems to be in between the long-term mortality for the two different types of surgical intervention, but closer to the long-term mortality after mitral valve replacement.…”

Adoption of minimally invasive mitral valve surgery: single-centre implementation experience in Vietnam

“…Mitral valve disease, particularly mitral regurgitation, affects a significant number of adults, making it the second most common reason for valve surgery 1 , 2 . Studies have demonstrated that mitral valve repair yields better outcomes compared to valve replacement for the treatment of mitral regurgitation 3 – 5 . In line with current guidelines, it is recommended to pursue early valve repair, even in the absence of symptoms, for individuals with severe mitral regurgitation at specialized heart valve centres 5 , 6 .…”