Abstract 20352: How Durable is Repair of Degenerative Mitral Regurgitation in the Young?
Introduction: The purpose of this study was to determine the performance of mitral repair in young patients with degenerative disease. Some have described a linear rate of valve repair failure, which, if accurate, would predict inevitable valve reoperation for young patients. This study was performed to determine the durability of repair of degenerative MR according to patient age.
Hypothesis: Failure of mitral valve repair is non-linear and is not influenced by the age of the patient presenting to surgery.
Methods: Between 2001-2016, 894 patients underwent repair of degenerative MR. Of these, 40 were <40 years of age at the time of surgery; 87 were between 40-50 years; 187 were between 51-60 years; 263 were between 61-70 years and 317 were ?70 at the time of surgery. Patients were assessed in a dedicated valve clinic and follow-up was for 5.0±3.8 years (extended to 13.8 years).
Results: Perioperative mortality was 0.3%. Younger patients were more likely to present to surgery with bileaflet prolapse compared to older patients (p=0.03); with 68% of patients <40 years presenting with bileaflet prolapse. Patients presenting to surgery at an older age were more likely female (p=0.007). Overall, 10-year survival was 79.7±2.2% (96.9±3.1% for patients <40 years and 94.5±3.4% for patients 41-50 years). Ten-year freedom from recurrent MR ≥2+ was 87.8±2.1% (97.2±2.7% for patients <40 years and 95.2±3.3% for patients 40-50 years). There was no difference in freedom from recurrent MR between patients <40 years and those in age deciles <70 years. However, recurrent MR was more likely to be observed in patients >70 years at the time of repair (p<0.03).
Conclusions: Mitral repair remains the gold-standard treatment of degenerative MR, which is particularly beneficial in young patients. Based on this longitudinal data, failure of degenerative MR failure was non-linear. In fact, there was no incremental negative impact of younger patient age on long-term repair durability, except in older patients.
Author Disclosures: V. Chan: None. E. Elmistekawy: None. M. Ruel: Honoraria; Modest; Medtronic (MICS CABG Proctor), Abbott Medical. M. Hynes: None. T. Mesana: None.
- © 2016 by American Heart Association, Inc.