Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Abstract

Background This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction. Methods From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed. Results The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up. Conclusions Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

Coaptation Reserve Predicts Optimal Reduction in Mitral Regurgitation and Long-Term Survival With Transcatheter Edge-to-Edge Repair

“…TEER therapy was performed with standard approaches using general anesthesia, intraoperative echocardiography, and fluoroscopy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] For all patients, transesophageal echocardiography was performed using IE 33 and EPIQ 7 machines with standard long-axis, commissural, and 3-dimensional views of the mitral valve anatomy (Philips, Andover, MA). All patients provided informed consent for the use of their medical record for research, which was conducted in accordance with the Declaration of Helsinki.…”

“…For patients with severe, symptomatic mitral regurgitation (MR), transcatheter edge-to-edge repair (TEER) has become an established therapy for high-risk patients with degenerative disease, as well as patients with secondary etiologies on a background of guideline-directed medical therapy. 1–14 The effectiveness and safety of TEER, primarily via MitraClip (Abbott Structural, Menlo Park, CA), has been evident in a broad range of mitral anatomies and in selected patients, has been associated with improved survival. Such clinical outcomes have fostered expanded use of the therapy, with now over 125 0000 patients treated worldwide, including >12 000 per year in the United States alone.…”

Do Not Withhold Mitral Surgery from Patients with Poor Left Ventricular Function

“…There are various risk factors that are empirically supported by clinical experience or proven by studies to make the decision for surgical treatment more challenging. These include the typical risk-factors already addressed in the EuroSCORE system and accumulating to a respective individual risk [3][4][5][6][7][8][9][10][11]. As a consequence, these patients are more and more often treated with a MitraClip, although the surgical treatment option would yield better and more stable results with the chance for the myocardium and other organ systems to recover sustainably.…”

Commentary: A stitch too far

“…The incidence of this complication in most series has been reported as <2%. 3 , 4 In addition, knowledge of the potential for this complication, prompt recognition when it occurs, and published responses have helped keep the rate of long-term consequences even lower. 5 Nonetheless, prevention is the ultimate goal.…”