Does Sustained Reduction of Functional Mitral Regurgitation Impact Survival?

• Published in: Seminars in thoracic and cardiovascular surgery 2024-01, Vol.36 (1), p.37-46
• Main Authors: Watt, Tessa M.F., Brescia, Alexander A., Murray, Shannon L., Rosenbloom, Liza M., Wisnielwski, Alexander, Burn, David, Romano, Matthew A., Bolling, Steven F.
• Format: Article
• Language: English
• Subjects: Functional mitral regurgitation; Ischemic heart disease; Mitral valve
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2023.04.003

[Display omitted] Functional mitral regurgitation (FMR) is associated with increased mortality and has been considered a marker for advanced heart disease, yet the value of mitral valve repair (MVr) in this population remains unclear. This study aims to evaluate the impact of reducing FMR burden through surgical MVr on survival. Patients with severe FMR who underwent MVr with an undersized, complete, rigid, annuloplasty between 2004 and 2017 were assessed (n = 201). Patients were categorized based on grade of recurrent FMR (0-4). Time-to-event Kaplan-Meier estimations of freedom from death or reoperation were performed using the log-rank test. Cox proportional hazards models evaluated all-cause mortality and reported in hazards ratios (HR) and 95% confidence intervals (CI). Patients were categorized by postoperative recurrent FMR: 45% (91/201) of patients had grade 0, 29% (58/201) grade 1, 20% (40/201) grade 2, 2% (4/201) grade 3%, and 4% (8/201) grade 4. The cumulative incidence of reoperation with death as a competing risk was higher in patients with grades ≥3 recurrent FMR compared to grades ≤2 (44.6% vs 14.6%, subhazard ratio 3.69 [95% CI, 1.17-11.6]; P = 0.026). Overall freedom from death or reoperation was superior for recurrent FMR grades ≤2 compared to grades ≥3 (log-rank P