Original Article
Early and long-term outcomes of mitral valve repair in degenerative mitral regurgitation
Tianyu Zhou, Jun Li, Hao Lai, Yongxin Sun, Kai Zhu, Jiawei Gu, Yulin Wang, Dingqian Liu, Wenjun Ding, Tao Hong, Chunsheng Wang
Published 2018-06-25
Cite as Chin J Thorac Cardiovasc Surg, 2018, 34(6): 335-338,343. DOI: 10.3760/cma.j.issn.1001-4497.2018.06.003
Abstract
ObjectiveThe aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.
MethodsFrom January 2003 to December 2015, clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively. There were 1 312 males(68.9%) and 591 females(31.1% )the mean age was(54.2±13.1)years. Early and long-term outcomes were summarized and risk factors for adverse events were assessed.
ResultsThere were 35 in-hospital deaths(1.8%) and in-hospital mortality for isolated mitral valve repair was 0.9%(10/1 163). Perioperative complications included central nerve system complications(0.7%), respiratory failure requiring tracheotomy(1.8%), acute renal injury requiring hemodialysis(1.2%) and reoperation for bleeding(0.7%). NYHA function class Ⅲ-Ⅳ(OR=3.65), atrial fibrillation(OR=2.85) and ejection fraction<0.6(OR=2.34) were identified as independent risk factors for in-hospital mortality. 12 years over follow-up, overall survival, freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85%、91% and 75%, respectively. Age>60 years(HR=7.43), preoperative stroke(HR=6.51), ejection fraction<0.6(HR=3.87), left ventricular end-systolic dimension>40 mm(HR=3.98) and pulmonary systolic pressure>50 mmHg(1 mmHg=0.133 kPa)(HR=2.85) were independent predictive factors for late death. Ejection fraction<0.6(HR=4.01), left ventricular end-diastolic dimension>60 mm(HR=1.88), leaflet lesion involving anterior leaflet(HR=2.40) and residue mild regurgitation(HR=4.17) were independent predictors for late recurrent regurgitation. Leaflet lesion involving anterior leaflet(HR=2.40) and residue mild regurgitation(HR=3.35) were independent predictor for late reoperation for mitral valve.
ConclusionMitral valve repair is safe and effective in degenerative mitral regurgitation. Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes. Early surgical intervention should be restricted in experienced high-volume centers.
Key words:
Mitral valve repair; Mitral regurgitation; Risk factors
Contributor Information
Tianyu Zhou
Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jun Li
Hao Lai
Yongxin Sun
Kai Zhu
Jiawei Gu
Yulin Wang
Dingqian Liu
Wenjun Ding
Tao Hong
Chunsheng Wang
