Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors.

Abstract

Mitral valve repair is the accepted treatment for mitral regurgitation (MR) but lack of resources and socioeconomic concerns delay surgical referral and intervention in developing countries. We evaluated immediate and short-term results of mitral valve repair for non-ischemic MR at our centre and aimed to identify the predictors of in-hospital and follow-up mortality. The study was conducted at a tertiary-level hospital in South India. All patients >18years with severe non-ischemic MR who underwent mitral valve repair over a period of 6years were included. Perioperative data was collected from hospital records and follow-up data was obtained by prospective methods. There were 244 patients (170 males). Most of the patients were in the age group 31-60years (76.6%). Aetiology of MR was degenerative (n= 159; 65.2%), rheumatic (n= 34; 13.9%), structural (n= 42; 17.2%), or miscellaneous (n= 9; 3.7%). All patients underwent ring annuloplasty with various valve repair techniques. One hundred patients (44.7%) underwent additional cardiac procedures. At discharge, MR was moderate in 4 patients; the rest had no or mild MR. The mean hospital stay of survivors was 7.1days (SD 2.52, range 5-25days). There were 9 in-hospital deaths (3.68%) and 10 deaths during follow-up (4.2%). The mean follow-up period was 1.39years, complete for 87.6%. Pre-operativeleft ventricle ejection fraction(LVEF) <60% (p= 0.04) was found to be significantly associated with immediate mortality. Logistic regression analysis detected age (p= 0.019), female sex (p= 0.015), and left ventricular (LV) dysfunction at discharge (p= 0.025) to be significantly associated with follow-up mortality. Pre-operative LV dysfunction was identified as a significant risk factor for in-hospital mortality. Female sex, age greater than 45years, and LV dysfunction at discharge were found to be significantly associated with follow-up mortality. Hence, it is important to perform mitral valve repair in severe regurgitation patients before significant LV dysfunction sets in for a better outcome.