Prognosis for Mitral Valve Repair Surgery in Functional Mitral Regurgitation

Abstract

Purpose: Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. Methods: A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted. Results: The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01-1.06, p = 0.016). Conclusion: Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.

Contemporary Surgical Treatment for Functional Mitral Regurgitation

“…Studies in the table focus on both ischemic and non-ischemic V-FMR, encompassing a wide range of patient profiles. 12,13,[27][28][29][30][31][32][33][34][35][36][37] Surgical approaches include mitral valve repair and mitral valve replacement. Ischemic V-FMR studies report relatively older patient populations, with mean ages ranging from 62 to 70 years, while non-ischemic V-FMR studies show slightly higher mean ages of 64-71 years.…”

Isolated annuloplasty in elderly patients with secondary mitral valve regurgitation: short- and long-term outcomes with a less invasive approach

“…Especially in elderly and often frail patients with multiple co-morbidities, surgical therapeutic options carry risk factors limiting their feasibility only to a highly select subset of patients ( 10 ). However, data on long-term results, especially in elderly patients who are refractory to OMT, remain inconclusive, leaving a gray area with a number of unanswered questions ( 11 , 12 ). Primary or consecutive implantation of long-term mechanical circulatory systems or heart transplantation is not feasible for broad application, or even not possible in patients above 70 years of age ( 13 – 15 ).…”