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. 2020 Oct 1;15(1):284.
doi: 10.1186/s13019-020-01309-6.

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Jun Li  1   2 , Yun Zhao  1   2 , Tianyu Zhou  3 , Yongshi Wang  2   4 , Kai Zhu  1   2 , Junyu Zhai  1   2 , Yongxin Sun  1   2 , Hao Lai  5   6 , Chunsheng Wang  7   8
Affiliations

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Jun Li et al. J Cardiothorac Surg. .

Abstract

Background: This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction.

Methods: From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed.

Results: The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up.

Conclusions: Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

Keywords: Degenerative mitral regurgitation; Left ventricular systolic dysfunction; Mitral valve repair.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves. Eight-year over follow-up, overall survival, freedom from reoperation for mitral valve and freedom from recurrent mitral regurgitation were 95.2, 83.7 and 56.9%, respectively
Fig. 2
Fig. 2
Comparison of freedom from recurrent MR between improved LV systolic function group (green line) and deteriorated LV systolic function group (red line) during follow-up. At eight years after operation, freedom from recurrent mitral regurgitation was 75.9% in improved LV systolic function group and 56.2% in deteriorated LV systolic function group (P = 0.04)
See this image and copyright information in PMC

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