Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation

Abstract

Background: Surgical treatment of functional mitral regurgitation (FMR) improves ventricular remodeling in patients with dilated cardiomyopathy (DCM). However, it is unclear whether surgical treatment improves long-term outcomes. We investigated the effects of mitral valve (MV) surgery in patients with DCM and FMR. Methods and Results:Of 525 patients with DCM hospitalized due to heart failure between January 1996 and September 2014, 70 who had severe FMR despite receiving optimal medical therapy were enrolled in the study. Of these patients, 16 underwent surgery for FMR (surgery group; repair=14, replacement=2); the remaining 54 who refused or decided not to undergo surgery were classified as the medication group. There were no differences in age, sex, medication, or echocardiographic parameters between the 2 groups (P>0.05). During the mean follow-up period of 53.6±43.6 months, the occurrence of clinical outcomes (i.e., all-cause death or left ventricular assist device implantation) was 54.3%; the occurrence of clinical outcomes was lower in the surgery group (P=0.008, log-rank test). Multivariate Cox regression analysis using clinical data revealed that MV surgery (hazard ratio [HR] 0.257, 95% confidence interval [CI] 0.103-0.640; P=0.004) and diabetes mellitus (HR 2.924, 95% CI 1.243-6.876; P=0.014) were independent predictors of clinical outcomes after adjusting for age and sex.Conclusions: Surgery for severe FMR provides better long-term outcomes in patients with DCM.

Outcomes and predictors of patients with moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy

“…Moreover, it has been reported that there was no significant survival benefit conferred by MVr for patients with FMR and nonischemic DCM. 8 However, Chung et al 18 reported that the correction of MR could improve the prognosis in these patients. In addition, Stone et al 24 in a cardiovascular outcomes assessment of the MitraClip percutaneous therapy (COPAT) study reported that transcatheter mitral-valve repair using the MitraClip device resulted in a lower rate of heart failure-related hospitalization and lower allcause death within 2 years of follow-up than medical therapy alone.…”

“…It was reported that patients with FMR and nonischemic DCM are associated with multiple comorbidities and poor long-term survival, with only 30% of the 5-year survival. 2,4,18,19 With the majority of studies focusing on the prognostic impact of ischemic MR or mixed FMR including ischemic cardiomyopathy and nonischemic DCM, 7,[20][21][22] there are scarce reports demonstrating the outcomes in patients with FMR and nonischemic DCM. Additionally, it remains controversial whether MVr improves survival.…”