216-67: Efficacy of surgical treatment of moderate to severe mitral regurgitation in patients scheduled for cardiac resynchronization therapy

Abstract

Purpose of the study; Mitral regurgitation (MR) in heart failure (HF) patients is generally associated with a poor prognosis. Cardiac resynchronization therapy (CRT) can reduce the degree of MR, improve symptoms and prognosis of HF patients. However, the significant residual MR after CTR is considered as a predictor of poor prognosis. The purpose of this study is to evaluate the clinical efficacy and prognosis of surgical treatment of moderate to severe MR in patients scheduled for CRT. Method used; A total of 23 consecutive patients scheduled for CRT with moderate to severe MR were enrolled between 2008 and 2015. 13 patients were performed mitral valve surgery (valvuloplasty 5 (38%), valve replacement 8 (62%); surgical group), and 10 patients were not performed (non-surgical group). In the surgical group, also coronary artery bypass 7 (54%), tricuspid annuloplasty 8 (62%), left ventricular epicardial lead placement 10 (77%) were performed simultaneously, and CRT were completed by endocardial lead added. All patients were evaluated MR change and major adverse cardiac events after CRT. Summary of results; MR improvement after CRT was significantly higher in the surgical group (surgical group 13 (100%) vs non-surgical group 3 (30%); p < 0.01), and MR worsening (0 (0%) vs 4 (40%); p < 0.05) and moderate to severe residual MR (1 (8%) vs 7 (70%); p < 0.01) were significantly lower in the surgical group.During the follow-up period (mean 38 ± 19 months), there were no significant between group differences in the total mortality rate, but cardiac death (2 (15%) vs 7 (70%); p < 0.05), and HF death (1 (8%) vs 6 (60%); p < 0.05) were significantly lower in the surgical group. Furthermore the surgical group showed a significantly higher rate of survival free of HF readmission (62.5% vs 22.2%; p < 0.05). Conclusion; Surgical treatment of moderate to severe MR in patients scheduled for CRT can significantly reduce the residual MR after CRT, may contribute to improve the prognosis and quality of life.