Late Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Background—The pathologic spectrum of degenerative diseases of the mitral valve (MV) that causes mitral regurgitation (MR) is broad and there is limited information on late outcomes of MV repair in various subgroups of patients and pathologies. This study examines this issue.
Methods and Results—All 840 patients who had MV repair for MR due to degenerative diseases from 1985 to 2004 were prospectively followed with clinical and echocardiographic evaluations at biennial intervals up to 26 years, median of 10.4 years. Clinical, hemodynamic, and pathologic variables were evaluated for their association with outcomes. Age, left ventricular ejection fraction, and functional class were predictors of late cardiac/valve related deaths by multivariable analysis. MV repair failed to restore life span to normal in patients with functional class IV. Thirty-eight patients had repeat MV surgery and probability of reoperation at 20 years was 5.9%. During the follow-up recurrent severe MR developed in 37 patients and moderate in 61. Age, isolated prolapse of the anterior leaflet, the degree of myxomatous changes in the MV, lack of mitral annuloplasty, and duration of cardiopulmonary bypass were associated with increased risk of recurrent MR. At 20 years the freedom from recurrent severe MR was 90.7%, and moderate or severe was 69.2%.
Conclusions—MV repair for degenerative MR restored life span to normal except in patients with symptoms at rest and/or impaired left ventricular function. Advanced age and complex mitral valve pathologies increased the risk of late recurrent MR.
- Received December 19, 2012.
- Revision received February 14, 2013.
- Accepted February 22, 2013.