TY - JOUR
T1 - Optimal versus suboptimal mitral valve repair
T2 - Late results in a matched cohort study
AU - de Bonis, Michele
AU - Zancanaro, Edoardo
AU - Lapenna, Elisabetta
AU - Trumello, Cinzia
AU - Ascione, Guido
AU - Giambuzzi, Ilaria
AU - Ruggeri, Stefania
AU - Meneghin, Roberta
AU - Abboud, Sabrin
AU - Agricola, Eustachio
AU - Forno, Benedetto Del
AU - Buzzatti, Nicola
AU - Monaco, Fabrizio
AU - Pappalardo, Federico
AU - Castiglioni, Alessandro
AU - Alfieri, Ottavio
N1 - Funding Information:
The Alfieri Heart Foundation supported data collection and analysis of this research.
Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - OBJECTIVES: After mitral repair for degenerative mitral regurgitation (MR), no or mild (<_1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study. METHODS: From 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR <_1+ (control group). The median follow-up was 8 years (interquartile range 6.3-10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed. RESULTS: Overall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR >_3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR >_2+ at 8 years with a significant increase over time (P < 0.001). CONCLUSIONS: Residual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process.
AB - OBJECTIVES: After mitral repair for degenerative mitral regurgitation (MR), no or mild (<_1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study. METHODS: From 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR <_1+ (control group). The median follow-up was 8 years (interquartile range 6.3-10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed. RESULTS: Overall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR >_3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR >_2+ at 8 years with a significant increase over time (P < 0.001). CONCLUSIONS: Residual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process.
KW - Long-term outcome
KW - Mitral regurgitation
KW - Mitral valve repair
KW - Residual mitral regurgitation
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U2 - 10.1093/ejcts/ezaa103
DO - 10.1093/ejcts/ezaa103
M3 - Article
C2 - 32298423
AN - SCOPUS:85088016809
VL - 58
SP - 328
EP - 334
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 2
ER -