Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation

Abstract

Background-Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation (MR). Yet, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative MR with a flail leaflet. Methods-MIDA is a multicenter registry enrolling patients with degenerative MR with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1,709) and replacement (n= 213), overall, by propensity score matching and by inverse probability-of-treatment weighting. Results-At baseline, patients undergoing MV repair were younger, had more comorbidities and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching as well as after inverse probability-of-treatment weighting, the 2 treatments groups were balanced and absolute standardized differences were usually below 10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement, both in the entire (1.3 vs 4.7%; p<0.001) and in propensity-matched population (0.2% vs 4.4%; p<0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement, both in the entire (46% vs 23%, p<0.001) and in matched population (41% vs 24%, p<0.001). Similar superiority of MV repair were obtained in patients' subsets based on age, sex or any stratification criteria (all p<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.Conclusions-Among patients with degenerative MR with a flail leaflet, referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival and fewer valve-related complications compared to MV replacement.

Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

“…(Ann Thorac Surg 2018;106:716-27) Ó 2018 by The Society of Thoracic Surgeons M itral valve (MV) surgery alleviates symptoms of heart failure, prevents or reverses ventricular remodeling, and decreases mortality in patients with severe MV disease. Contemporary trends in the therapy of patients with MV disease include an enhanced understanding of the benefits of timely referral for operation [1,2], acknowledgment of the superiority of repair compared with replacement for degenerative mitral regurgitation [3,4], and improved operative outcomes [3]. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) data elements were updated in 2011 to provide a more complete and accurate assessment of MV disease etiology as well as operative therapy, and outcomes.…”

Infective endocarditis following transcatheter edge‐to‐edge mitral valve repair: A systematic review

“…Interestingly, mitral valve repair has been associated with a lower risk of IE compared to mitral valve replacement. In a recent report from the Mitral Regurgitation International Database (MIDA), the overall 20‐year rate of IE following mitral valve repair or replacement in patients with severe degenerative MR was 0.8% (63% requiring reintervention), with a higher percentage of patients free from IE following mitral valve repair (vs. replacement) . The double‐orifice edge‐to‐edge technique has also been associated with a low incidence of IE.…”

Inhibition and down regulation of the serotonin transporter contribute to the progression of degenerative mitral regurgitation

“…Fluoxetine, a representative SSRI, enhances plat activation, and increases platelet secretion of 5HT thus enhancing HTR signaling ( Figure 3A-C). Asp administration inhibits platelet activation ( Figure 3) and thus, could mitigate MR progression by reducing plat activation associated 5HT release from platelets ( Figure 3D-F Age range (years) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)…”

“…Degenerative mitral regurgitation (MR), due to myxomatous mitral valve disease 23 , when severe can only be treated surgically 24,25 . There is little known about 5HT-mechanisms and MR. 21,26 .…”