title: Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease.
abstract: BACKGROUND
  The pathological spectrum of degenerative diseases of the mitral valve (MV) that causes mitral regurgitation (MR) is broad, and there is limited information on late outcomes of MV repair in various subgroups of patients and pathologies. This study examines this issue.
  
  
  RESULTS
  All 840 patients who had MV repair for MR due to degenerative diseases from 1985 to 2004 were prospectively followed with clinical and echocardiographic evaluations at biennial intervals up to 26 years, median of 10.4 years. Clinical, hemodynamic, and pathological variables were evaluated for their association with outcomes. Age, left ventricular ejection fraction, and functional class were predictors of late cardiac- and valve-related deaths by multivariable analysis. MV repair failed to restore life span to normal in patients with functional class IV. Thirty-eight patients had repeat MV surgery, and the probability of reoperation at 20 years was 5.9%. During the follow-up, recurrent severe MR developed in 37 patients, and moderate MR developed in 61. Age, isolated prolapse of the anterior leaflet, the degree of myxomatous changes in the MV, lack of mitral annuloplasty, and duration of cardiopulmonary bypass were associated with increased risk of recurrent MR. At 20 years, the freedom from recurrent severe MR was 90.7%, and the freedom from moderate or severe MR was 69.2%.
  
  
  CONCLUSIONS
  MV repair for degenerative MR restored life span to normal except in patients with symptoms at rest and impaired left ventricular function. Advanced age and complex mitral valve pathologies increased the risk of late recurrent MR.
authors: Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.ca.
authors: Tirone E
authors: TE
authors: David
authors: Susan
authors: S
authors: Armstrong
authors: Brian W
authors: BW
authors: McCrindle
authors: Cedric
authors: C
authors: Manlhiot
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects* / Q000401:mortality*; D004452:Echocardiography; D004696:Endocarditis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013318:Stroke Volume; D013923:Thromboembolism / Q000401:mortality; D016896:Treatment Outcome