Long-Term Results of Mitral Valve Repair for Regurgitation Due to Leaflet Prolapse

• Published in: Journal of the American College of Cardiology 2019-08, Vol.74 (8), p.1044-1053
• Main Authors: David, Tirone E., David, Carolyn M., Tsang, Wendy, Lafreniere-Roula, Myriam, Manlhiot, Cedric
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Bleeding; Cardiac arrhythmia; Cardiology; Clinical outcomes; Cohort Studies; Confidence intervals; Degeneration; Degenerative diseases; degenerative diseases of the mitral valve; Endocarditis; Fatalities; Female; Fibrillation; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; mitral regurgitation; Mitral valve; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - surgery; mitral valve repair; Mortality; Patients; Prospective Studies; Regurgitation; Reoperation - trends; Repair; Statistical analysis; Surgery; Thromboembolism; Time Factors; Ultrasonic imaging; Vascular implants
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.06.052

Mitral valve (MV) repair has become the standard therapy for mitral regurgitation (MR) due to degenerative diseases, but information on late outcomes is limited. The purpose of this study was to examine the late results of MV repair for MR in a large cohort of patients. A total of 1,234 consecutive patients (median age 59 years; 70.4% men) had MV repair for MR due to leaflet prolapse and were followed prospectively for a median of 13 years (interquartile range: 8 to 34 years) with periodical echocardiographic studies. There were 163 patients still at risk at 20 years. Cumulative incidences of adverse events and associated factors were examined with death as a competing outcome. At 20 years, reoperation-free survival was 60.4% (95% confidence interval: 56.2% to 64.2%) and the cumulative incidence of cardiac and valve-related deaths was 12%, noncardiac deaths 21.3%, reoperation on the MV 4.6%, infective endocarditis 1.1%, thromboembolism 10.3%, and bleeding 6.4%. The probability of recurrent moderate or severe MR was 12.5%, persistent or new moderate or severe tricuspid regurgitation (TR) 20.8%, and new atrial fibrillation (AF) 32.4%. Multivariable analysis identified older age, complete heart block, MV repair without annuloplasty ring, and the degree of myxomatous degeneration of the MV to be associated with recurrent MR. The development of AF and TR was unrelated to recurrent MR. MV reoperation was uncommon after MV repair, but there was an increasing incidence of recurrent MR, TR, and new AF over time. [Display omitted]