title: Long-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function.
abstract: OBJECTIVE
  The timing for mitral valve surgery in asymptomatic patients with severe mitral regurgitation and preserved left ventricular function remains controversial. We analyzed the immediate and long-term outcomes of these patients after surgery.
  
  
  METHODS
  From January 1992 to December 2012, 382 consecutive patients with severe chronic degenerative mitral regurgitation, with no or mild symptoms, and preserved left ventricular function (ejection fraction ≥ 60%) were submitted to surgery and followed for up to 22 years (3209 patient-years). Patients with associated surgeries, other than tricuspid valve repair, were excluded. Cox proportional-hazard survival analysis was performed to determine predictors of late mortality and mitral reoperation. Subgroup analysis involved patients with atrial fibrillation or pulmonary hypertension.
  
  
  RESULTS
  Mitral valvuloplasty was performed in 98.2% of cases. Thirty-day mortality was 0.8%. Overall survival at 5, 10, and 20 years was 96.3% ± 1.0%, 89.7% ± 2.0%, and 72.4% ± 5.8%, respectively, and similar to the expected age- and gender-adjusted general population. Patients with atrial fibrillation/pulmonary hypertension had a 2-fold risk of late mortality compared with the remaining patients (hazard ratio, 2.54; 95% confidence interval, 1.17-4.80; P = .018). Benefit was age-dependent only in younger patients (<65 years; P = .016). Patients with atrial fibrillation/pulmonary hypertension (hazard ratio, 4.20, confidence interval, 1.10-11.20; P = .037) and patients with chordal shortening were at increased risk for reoperation, whereas patients with P2 prolapse (hazard ratio, 0.06; confidence interval, 0.008-0.51; P = .037) and patients with myxomatous valves (hazard ratio, 0.072; confidence interval, 0.008-0.624; P = .017) were at decreased risk.
  
  
  CONCLUSIONS
  Mitral valve repair can be achieved in the majority of patients with low mortality (<1%) and excellent long-term survival. Patients with atrial fibrillation/pulmonary hypertension had compromised long-term survival, particularly younger patients (aged <65 years), and are at increased risk of mitral reoperation.
authors.affiliation: Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.
authors.forename: Gonçalo F
authors.initials: GF
authors.lastname: Coutinho
authors.affiliation: Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.
authors.forename: Ana Luis
authors.initials: AL
authors.lastname: Garcia
authors.affiliation: Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Correia
authors.affiliation: Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Branco
authors.affiliation: Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal. Electronic address: antunes.cct.huc@sapo.pt.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Antunes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000401:mortality; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left