Abstract 12805: Mitral Valve Repair for Medically-Refractory Functional Mitral Regurgitation in Patients with End-Stage Renal Disease and Advanced Heart Failure
Objective: Data on patient selection and outcome of mitral valve (MV) repair for chronic kidney disease (CKD) or end-stage renal disease (ESRD) patients with severe heart failure are limited.
Methods: We classified 226 patients (180 men, 46 women; mean age 65±10 years) undergoing restrictive mitral annuloplasty (RMA) for functional mitral regurgitation (MR) (regurgitant volume >30 ml per beat) into 3 groups; those with creatinine (Crn) <2.0 mg/dL (CKD stages 1-3, Control, n=164), Crn >2.0 mg/dL, not dependent on hemodialysis (CKD stages 4-5, Non-HD, n=42), and with ESRD on hemodialysis (On-HD, n=20). All had Stage C or D heart failure symptoms. Mean duration of preoperative hemodialysis was 83±92 months (range, 3-300 months). Mean follow-up for survivors was 41±24 months (range: 2-126 months).
Results: Operative mortality was 1.9%, 2.8%, and 5.6% in the Control, Non-HD, and On-HD groups, respectively (p=NS). Postoperative cardiac catheterization at 1 month post-RMA showed that LV end-systolic volume index decreased from 113±38 to 83±41ml/m2, 104±29 to 81±29 ml/m2, and 121±45 to 71±29 ml/m2, in the Control, Non-HD, and On-HD groups (p<0.001 for all). LV end-diastolic pressure decreased from 19±7 to 15±6 mmHg, 19±9 to 14±8 mmHg, and 22±8 to 11±3 mmHg, respectively (p<0.01 for all), while cardiac output increased from 4.1±1.2 to 4.5±1.2 L/min, 3.7±0.8 to 4.3±1.1 L/min, and 4.4±1.1 to 4.9±1.6 L/min (p<0.01 for all), with no intergroup differences for those postoperative values. During the follow-up, there were no differences in the medium-term overall survival and event-free survival rates between the On-HD and Control groups (p=0.14 and p=0.66, respectively), but those rates were substantially worse in the Non-HD (p<0.01 for both) (Figure).
Conclusions: In patients with ESRD on hemodialysis and Stage C/D heart failure, MV repair for medically-refractory functional MR may be reasonable with a low operative mortality, and provide hemodynamic and survival benefits.
- © 2011 by American Heart Association, Inc.