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Outcomes of mitral valve surgery for severe ischemic mitral regurgitation
Author(s) -
Dufendach Keith,
ArandaMichel Edgar,
Sultan Ibrahim,
Gleason Thomas G.,
Navid Forozan,
Thoma Floyd,
Kilic Arman
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14395
Subject(s) - medicine , mitral regurgitation , mitral valve replacement , concomitant , mitral valve repair , cardiology , mitral valve , surgery
Abstract Background This study evaluated outcomes of mitral valve surgery for severe ischemic mitral regurgitation (IMR). Methods Patients undergoing coronary artery bypass grafting (CABG) with concomitant mitral valve repair (MVr) or replacement (MVR) for severe IMR at a single center between 2010 and 2017 were included. The primary outcome was 5‐year survival. Secondary outcomes included operative mortality and morbidity, hospital readmission, recurrence of at least moderate mitral regurgitation (MR), and mitral valve reoperation. Results A total of 358 patients underwent concomitant mitral valve surgery with CABG for severe IMR (275 MVr and 83 MVR). Unadjusted and risk‐adjusted operative mortality was higher in MVR (16% vs 8%; P = .04). MVR patients had higher rates of postoperative renal failure, prolonged ventilation, and deep sternal wound infection. The unadjusted 5‐year survival was similar (MVR 64% vs MVr 64%; P = .41), a finding that persisted after risk‐adjustment. The 5‐year freedom from mitral valve reoperation was 96% and 97% ( P = .47). Freedom from at least moderate MR at 1‐year and 3‐years was 100% vs 86% ( P = .09) and 100% vs 68% ( P = .06) for MVR and MVr, respectively. However, only three MVr patients developed severe MR by 3 years. Cumulative hazards for all‐cause readmission and heart failure‐specific readmission were higher with MVR. Conclusions Despite a trend towards higher risk of MR recurrence, patients undergoing MVr have similar rates of survival and mitral valve reoperation, with lower rates of readmission at 5‐years. This, combined with lower operative mortality rates, makes MVr a reasonable choice particularly in sicker patients with higher operative risk and more limited life expectancy.