Long-term clinical outcome of mitral valve repair in asymptomatic severe mitral regurgitation

Eur J Cardiothorac Surg. 2009 Sep;36(3):539-45. doi: 10.1016/j.ejcts.2009.02.063. Epub 2009 Jul 25.

Abstract

Objective: To assess the long-term survival, the incidence of cardiac complications and the factors that predict outcome in asymptomatic patients with severe degenerative mitral regurgitation (MR) undergoing mitral valve repair.

Methods: Up to 143 asymptomatic patients (mean age 63+/-12 years) with severe degenerative MR who underwent mitral valve repair between 1990 and 2001 were subsequently followed up for a median of 8 years. The study population was subdivided into three subgroups: patients with left ventricular (LV) dysfunction and/or dilatation (n=18), patients with atrial fibrillation and/or pulmonary hypertension (n=44) and patients without MR-related complications (n=81).

Results: For the patients, 10-year overall and cardiovascular survival was 82+/-4% and 90+/-3%. At 10 years, patients without preoperative MR-related complications had significantly better overall survival than patients with preoperative LV dysfunction and/or dilatation (89+/-4% vs 57+/-13%, log rank p=0.001). Patients without preoperative MR-related complications also tended to have a better 10-year overall and cardiovascular survival than patients with atrial fibrillation and/or pulmonary hypertension (overall survival of 79+/-8%), although this did not reach statistical significance (log rank p=0.17). Cox regression analysis identified the baseline left ventricular ejection fraction and age as the sole independent predictors of outcome.

Conclusion: Our data indicate that in asymptomatic patients with severe degenerative MR, mitral valve repair is associated with an excellent long-term prognosis. Nonetheless, the presence of preoperative MR-related complications, in particular LV dysfunction and/or dilatation, greatly attenuates the benefits of surgery. This suggests that mitral valve repair should be performed early, before any MR-related complications ensue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / etiology
  • Epidemiologic Methods
  • Female
  • Humans
  • Hypertension, Pulmonary / etiology
  • Male
  • Middle Aged
  • Mitral Valve / surgery*
  • Mitral Valve Insufficiency / complications
  • Mitral Valve Insufficiency / surgery*
  • Postoperative Complications
  • Prognosis
  • Recurrence
  • Reoperation / statistics & numerical data
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left / etiology