Abstract 4620: Moderate to Severe Residual Ischemic Mitral Regurgitation After Anuloplasty Leads to Outcomes Similar to Those After More Complete Initial Repair: Implications for Percutaneous Repair
Background: Ischemic heart disease causes mitral regurgitation (MR) through LV remodeling and apical tethering. Percutaneous repair of ischemic MR is feasible, but often leaves MR ≥2+. We hypothesized that residual MR (MR ≥2+) after surgical anuloplasty would lead to worse outcomes vs MR <2+.
Methods: From 1/1986–1/2008, 1,326 patients with ischemic MR underwent anuloplasty±CABG. Of these, 881 survived 30 days and had a TTE. At first qualifying postop TTE, 133 patients had MR ≥2+ and 748 MR <2+. Propensity score methodology was used to match 130 patient pairs for analysis of outcomes; 122 had ≥2 postop TTEs (375 total) for assessing MR progression. There were 522 and 1,141 patient-years of follow-up to assess prevalence of MV reoperation and all-cause mortality, respectively.
Results: Patients with postop MR ≥2+ had higher preop MR grade, earlier surgery date, and greater LVES diameter; those with MR <2+ were more likely to have concomitant CABG. Patients with MR ≥2+ had more severe MR (3+/4+) at 6 mo (P=.0002), but similar MR grade after 2 y (P=.7; Fig⇓). Additionally, they required more early reoperations (10% vs. 1% by 1 y; Fig⇓), but there was no overall difference in risk for reoperation between matched groups (P>.9). Survival at 6 mo and 1, 3, 5, and 10 y was similar (89%, 85%, 73%, 61%, and 37% for MR ≥2+ vs. 85%, 80%, 68%, 57%, and 35% for MR <2+; P=.3 [<1 y] and P=0.9 [≥1 y]).
Conclusion: Surgical anuloplasty for ischemic MR is associated with residual MR ≥2+ in 15% of patients, which requires more early reoperation vs MR <2+. However, differences in MR grade and survival after 2 y are similar. Thus, a percutaneous procedure resulting in residual moderate or greater MR may be acceptable.