Abstract 2306: Determinants of Long-term Survival after Mitral Valve Repair in Patients with Severe Organic Mitral Regurgitation
Surgery for severe organic mitral regurgitation (OMR) is indicated when symptoms, LV dysfunction, atrial fibrillation (AF), and/or pulmonary hypertension (PHT) are present (ACC/AHA guidelines). The aim of this study was to investigate whether symptoms, LV dysfunction, AF or PHT had an impact on long-term survival in patient with severe OMR undergoing mitral valve repair (MVRp). 323 patients (61.4±12yrs, 67% of male) with severe OMR undergoing MVRp were included (mean f-up=5.6±3.9yrs). Symptomatic patients (60%) had significantly lower 10-year survival than those with no/mild symptoms (75±5% vs. 89±2%, p=0.04). Patients with LV dysfunction (LVEF<65%) had markedly lower survival compared to those with preserved LV function (75±3% vs. 90±4%; p=0.002). Patients with no/mild symptoms and preserved LVEF (18%) had better 10-year survival than other patients (100±0% vs. 76±4%, p=0.01). Interestingly, 52% of patients with no/mild symptoms nonetheless had LV dysfunction and they had lower survival compared to patients with preserved LV function (86±7% vs. 100±0%, p=0.02). On univariate analysis, as opposed to age, male gender and stroke (p<0.001), AF and PHT had no significant impact on survival. On multivariate analysis, the independent predictors of mortality were older age (Hazard-ratio [HR]=1.7, [95% confidence interval (CI):1.2–2.5], p=0.005), stroke (HR=1.9, 95%CI:1.1–3.1, p=0.03) and LV dysfunction (HR=2.1, 95%CI: 1.3–3.1, p=0.0004). There was a trend for symptoms to be an independent predictor of mortality (HR=1.46, 95%CI:0.95–2.4, p=0.08). Moreover, after adjusting for age, gender, AF, stroke, and PHT, LV dysfunction and/or symptoms was associated with an increase in mortality risk (HR=2.7, 95%CI:1.24 –11.3, p=0.01), when compared to patients with no/mild symptoms and preserved LV function. In patients with severe OMR, reduced LVEF is the most powerful independent predictor of long-term survival after MVRp. The presence of LV dysfunction is frequent in patients with no/mild symptoms suggesting that LVEF should be followed closely in these patients. Moreover, the results of this study provide support in favour of the realization of MVRp prior the onset of LV dysfunction or important symptoms.