Sport practice after mitral valve repair for primary mitral regurgitation: Are we not too restrictive?

Abstract

Sport practice for competitive and leisure athlete is restrictive after mitral valve repair (MVR) despite excellent long-term results with mortality rate similar to that of the general population. We hypothesized that sport and a high level of physical activity have no impact on surgical outcome after MVR. Patients aged from 18 to 65 years undergoing single MVR for primary mitral regurgitation (MR) at CHU de Toulouse were included from January 2010 to March 2017. Exclusion criteria were previous cardiac surgery, other concomitant procedure except tricuspid annuloplasty or atrial fibrillation (AF) ablation, death or reoperation, contraindication to normal activity. Primary endpoint was: tardive post-operative AF (TAF) (> 3 month); mitral valve failure (VF) defined as MR >1 or average gradient (AG) >8 mmHg; heart failure (HF). Practice of sport was assessed in hour per week during last 6 month and classified according to Mitchell classification; physical activity was assessed by IPAQ (International physical Activity questionnaire) short form. Among 196 procedures during this period, 61 patients were excluded, 14 lost to follow up and 121 patients included. Medium age was 50 ± 11. Median follow up was 33.9 (19.7–49.8) months. 56 patients practice regular sport activity with median 3 (1.9–5) hours per week and 11 (19.6%) at least 6 hours. IPAQ continuous score was 1674 met.min.week (792–3572) and 42 (34.7%) reached IPAQ 3 very active group. Twenty events occurred: 7 TAF (5.8%); 13 VF (10.7%; 5 MR > 1 and 8 AG > 8 mmHg), 0 HF. There was no relation between primary endpoint and practice of sport ( P = 0.54), all Mitchel classification sub-groups, high sport practice (> 6 hours) ( P = 0.49), IPAQ 1 ( P = 0.94), IPAQ 2 ( P = 0.59), IPAQ 3 ( P = 0.63) and IPAQ continuous score ( P = 0.4). None of 4 death and 3 reoperations were related to sport ( Table 1 ). Sport or high physical activity seems not related to primary endpoint in this very active cohort.