Long-term outcome after mitral valve repair: a risk factor analysis.
OBJECTIVE
Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome.


METHODS
We retrospectively studied our first 175 consecutive adult patients (mean age: 64+/-10.4 years; 113 males) who underwent primary mitral valve repair associated with any other cardiac procedures between January 1986 and December 1998. Risk factors influencing reoperations and late survival were plotted in a uni- and multivariate analyses.


RESULTS
Operative mortality was 3.4% (6 deaths, 0-22nd postoperative day (POD)). Late mortality was 9.1% (16 deaths, 3rd-125th POM). Reoperation was required in five patients. Kaplan-Meier actuarial analysis demonstrated a 96+/-1% 1-year survival, 88+/-3% 5-year survival and a 69+/-8% 10-year survival. Freedom from reoperations was 99% at 1 year after repair, 97+/-2% after 5 years and 88+/-6% after 10 years. Multivariate analysis demonstrated that residual NYHA class III and IV (p=0.001, RR 4.55, 95% CI: 1.85-14.29), poor preoperative ejection fraction (p=0.013, RR 1.09, 95% CI: 1.02-1.18), functional MR (p=0.018, RR 4.17, 95% CI: 1.32-16.67), and ischemic MR (p=0.049, RR 3.13, 95% CI: 1.01-10.0) were all independent predictors of late death. Persistent mitral regurgitation at seventh POD (p=0.005, RR 4.55, 95% CI: 1.56-20.0), age below 60 (p=0.012, RR 8.7, 95% CI: 2.44-37.8), and absence of prosthetic ring (p=0.034, RR 4.76, 95% CI: 1.79-33.3) were all independent risk factors for reoperation.


CONCLUSIONS
Mitral valve repair provides excellent survival. However, long-term outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral regurgitation and without ring annuloplasty.
Meyer
Marie-Antoinette Rey
MA
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
von Segesser
Ludwig K
LK
Hurni
Michel
M
Stumpe
Frank
F
Eisa
Karam
K
Ruchat
Patrick
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome