Long-term outcome after mitral valve repair: a risk factor analysis

• Published in: European journal of cardio-thoracic surgery 2007-08, Vol.32 (2), p.301-307
• Main Authors: Rey Meyer, Marie-Antoinette, von Segesser, Ludwig K., Hurni, Michel, Stumpe, Frank, Eisa, Karam, Ruchat, Patrick
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mitral regurgitation; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Mitral valve repair; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Treatment Outcome; Univariate and multivariate analysis
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2007.05.008

Objective: Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome. Methods: We retrospectively studied our first 175 consecutive adult patients (mean age: 64 ± 10.4 years; 113 males) who underwent primary mitral valve repair associated with any other cardiac procedures between January 1986 and December 1998. Risk factors influencing reoperations and late survival were plotted in a uni- and multivariate analyses. Results: Operative mortality was 3.4% (6 deaths, 0–22nd postoperative day (POD)). Late mortality was 9.1% (16 deaths, 3rd–125th POM). Reoperation was required in five patients. Kaplan–Meier actuarial analysis demonstrated a 96 ± 1% 1-year survival, 88 ± 3% 5-year survival and a 69 ± 8% 10-year survival. Freedom from reoperations was 99% at 1 year after repair, 97 ± 2% after 5 years and 88 ± 6% after 10 years. Multivariate analysis demonstrated that residual NYHA class III and IV (p = 0.001, RR 4.55, 95% CI: 1.85–14.29), poor preoperative ejection fraction (p = 0.013, RR 1.09, 95% CI: 1.02–1.18), functional MR (p = 0.018, RR 4.17, 95% CI: 1.32–16.67), and ischemic MR (p = 0.049, RR 3.13, 95% CI: 1.01–10.0) were all independent predictors of late death. Persistent mitral regurgitation at seventh POD (p = 0.005, RR 4.55, 95% CI: 1.56–20.0), age below 60 (p = 0.012, RR 8.7, 95% CI: 2.44–37.8), and absence of prosthetic ring (p = 0.034, RR 4.76, 95% CI: 1.79–33.3) were all independent risk factors for reoperation. Conclusions: Mitral valve repair provides excellent survival. However, long-term outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral regurgitation and without ring annuloplasty.