Long-term clinical outcome of mitral valve repair in asymptomatic severe mitral regurgitation.
OBJECTIVE
To assess the long-term survival, the incidence of cardiac complications and the factors that predict outcome in asymptomatic patients with severe degenerative mitral regurgitation (MR) undergoing mitral valve repair.


METHODS
Up to 143 asymptomatic patients (mean age 63+/-12 years) with severe degenerative MR who underwent mitral valve repair between 1990 and 2001 were subsequently followed up for a median of 8 years. The study population was subdivided into three subgroups: patients with left ventricular (LV) dysfunction and/or dilatation (n=18), patients with atrial fibrillation and/or pulmonary hypertension (n=44) and patients without MR-related complications (n=81).


RESULTS
For the patients, 10-year overall and cardiovascular survival was 82+/-4% and 90+/-3%. At 10 years, patients without preoperative MR-related complications had significantly better overall survival than patients with preoperative LV dysfunction and/or dilatation (89+/-4% vs 57+/-13%, log rank p=0.001). Patients without preoperative MR-related complications also tended to have a better 10-year overall and cardiovascular survival than patients with atrial fibrillation and/or pulmonary hypertension (overall survival of 79+/-8%), although this did not reach statistical significance (log rank p=0.17). Cox regression analysis identified the baseline left ventricular ejection fraction and age as the sole independent predictors of outcome.


CONCLUSIONS
Our data indicate that in asymptomatic patients with severe degenerative MR, mitral valve repair is associated with an excellent long-term prognosis. Nonetheless, the presence of preoperative MR-related complications, in particular LV dysfunction and/or dilatation, greatly attenuates the benefits of surgery. This suggests that mitral valve repair should be performed early, before any MR-related complications ensue.
Chenot
Fabien
F
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10-2881, B-1200 Brussels, Belgium.
Montant
Patrick
P
Vancraeynest
David
D
Pasquet
Agnès
A
Gerber
Bernhard
B
Noirhomme
Philippe Henri
PH
El Khoury
Gébrine
G
Vanoverschelde
Jean-Louis
JL
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology