title: Effect of Recurrent Mitral Regurgitation Following Degenerative Mitral Valve Repair: Long-Term Analysis of Competing Outcomes.
abstract: BACKGROUND
  The risk for and consequences of recurrent mitral regurgitation (MR) following degenerative mitral valve repair are poorly understood.
  
  
  OBJECTIVE
  This study sought to examine recurrent MR risk along with reoperation and survival rates.
  
  
  METHODS
  We evaluated patients undergoing primary mitral repair for isolated degenerative MR over 1 decade. Median follow-up was 11.5 years (interquartile range: 9.2 to 13.6 years) and was 99% complete. Multivariate analysis of post-repair MR recurrence employed Cox proportional hazards and multistate modeling.
  
  
  RESULTS
  A total of 1,218 patients met the study criteria; the mean age was 64 ± 13 years, mean ejection fraction was 63 ± 9%, and 864 (71%) patients were men. Prolapse was posterior in 62%, bileaflet in 26%, and anterior in 12%. The 15-year incidence of recurrent MR (i.e., MR ≥2) was 13.3%, incidence of mitral reoperation was 6.9%, and overall mortality was 44.0%. Repair before 1996 independently predicted MR recurrence (hazard ratio: 1.52). Additional determinants were: age, mild intraoperative residual MR, anterior leaflet prolapse, bileaflet prolapse, perfusion time >90 min, and lack of annuloplasty. Recurrence of moderate or greater MR was associated with adverse left ventricular remodeling and increased likelihood of death (hazard ratio: 1.72). Among those undergoing repair after 1996, MR recurrence rate was 1.5 per 100 patient-years during the first year post-repair, decreasing markedly to 0.9 thereafter.
  
  
  CONCLUSIONS
  Our study demonstrated that recurrent MR following degenerative mitral valve repair is associated with adverse left ventricular remodeling and late death. The incidence of MR recurrence decreases markedly following the first year after intervention. A transparent discussion of recurrent MR risk has pressing relevance when referring patients with complex mitral valve prolapse.
authors: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: surir@ccf.org.
authors: Rakesh M
authors: RM
authors: Suri
authors: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec City, Québec, Canada.
authors: Marie-Annick
authors: MA
authors: Clavel
authors: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Hartzell V
authors: HV
authors: Schaff
authors: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Hector I
authors: HI
authors: Michelena
authors: Department of Statistics and Probability, Michigan State University, East Lansing, Michigan.
authors: Marianne
authors: M
authors: Huebner
authors: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Rick A
authors: RA
authors: Nishimura
authors: Department of Statistics and Probability, Michigan State University, East Lansing, Michigan.
authors: Maurice
authors: M
authors: Enriquez-Sarano
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D020257:Ventricular Remodeling
keywords: leaflet; left ventricular; recurrence; reoperation