Abstract 2286: Short- and Long-Term Survival of Mitral Valve Repair Versus Mitral Valve Replacement in Patients with Functional Mitral Regurgitation

Abstract

Mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR) when compared to mitral valve replacement (MVR). However, there is an important controversy about the type of surgical treatment that should be used in patients with functional MR (FMR). The aim of this study was to compare MVRp (i.e. restrictive annuloplasty) and MVR in patients with FMR. Pre- and operative demographic and clinical data of 392 patients (64% of male, mean age: 65±10 years) with FMR who underwent mitral surgery between 1992 and 2007 were prospectively collected in a computerized database. MVRp was performed in 52% of patients (n=204) and MVR in 48% (n=188). Compared to patients undergoing MVRp, those with MVR were significantly more frequently symptomatic (77% vs. 59%, p=0.0002), had lower left ventricular ejection fraction (LVEF) (40±15%, vs. 46±15%, p=0.0003) and had higher prevalence of pulmonary hypertension (36% vs. 24%, p=0.01) preoperatively. However, there was no significant difference between the 2 groups with regards to age, gender, MR severity, diabetes, obesity, systemic hypertension and atrial fibrillation (p>0.3). Although operative mortality was significantly lower after MVRp compared to MVR (9% vs. 17%, p=0.02), long-term survival was not statistically different between procedures (6 years: 74±4% vs. 72±4%; 12 years: 54±5% vs. 52±7%; p=0.58). After adjusting for other risk factors, the type of procedure (MVRp vs. MVR) did not come out as an independent predictor of either operative (Odds-ratio=1.7, 95% confidence interval [CI]: 0.8 –3.8, p=0.15) or long-term mortality (Hazard-ratio [HR]=1.1, 95%CI: 0.9 –1.4, p=0.29). The independent predictors of long-term mortality were age (HR= 1.04, 95%CI: 1.01–1.07, p=0.003), NYHA class ≥III (HR=1.4, 95%CI: 1.1–2, p=0.02) and LVEF (HR=1.02, 95%CI: 1.01–1.04, p=0.0009). As opposed to what has been reported in patients with organic MR, there is no evidence that MVRp provides any benefit in terms of survival compared to MVR in patients with FMR. These findings suggest that MVRp is not an optimal surgical treatment for FMR and provide an impetus toward the development of new surgical approaches for these patients.