0414 : Very long term survival after mitral repair vs replacement. A propensity score analysis of a large, prospective, multicenter international registry

Abstract

Despite the absence of randomized studies comparing mitral valve (MV) repair and replacement, international guidelines strongly recommend MV repair as the optimal surgical treatment for severe degenerative mitral regurgitation (dMR). Yet, the level of evidence supporting these recommendations is low, owing to the lack of available clinical trial data. In this context, analysis of large multicenter registries becomes critical. To compare very long-term survival among patients (pts) undergoing MV repair versus replacement for the treatment of severe dMR using the technique of propensity score (PS) matching to reduce bias in nonrandomized cohorts. The Mitral Regurgitation International DAtabase (MIDA) is a prospective multicenter registry that includes 2,569 consecutive pts with dMR, who were recruited in 6 tertiary centers (France, Italy, Belgium, and the United States) between 1980 and 2005. Among these, we identified 1,922 pts who underwent mitral surgery, including 1,709MV repairs and 213MV replacements. We compared operative mortality and overall survival in both the entire study population and in 615 PS-matched (2:1) pts. Operative mortality was lower after MV repair than after MV replacement, both in the entire population (2 vs 7%; p=0.001) and in the PSmatched pts (4 vs 8%; p=0.04). Similarly, 20-year survival was better after MV repair than after MV replacement, both in the entire population (46% [(95% CI, 39%-52%] vs 23% [95% CI, 14%-32%], p<0.001) and in the PSmatched pts (41% [95% CI, 28%-54%] vs 24% [95% CI, 14%-33%], p<0.001). Similar results were obtained in pts aged < 65 years (p<0.005), 65- 74 years (p<0.001) and ε75 years (p<0.001). Among registry pts with dMR, performance of MV repair resulted in lower operative mortality and greater long-term survival compared to MV replacement, thus supporting current international recommendations.