Mitral valve replacement versus repair for severe mitral regurgitation in patients with reduced left ventricular ejection fraction

Abstract

Objective

This study compares early and long-term outcomes following mitral valve (MV) repair and replacement in patients with mitral regurgitation (MR) and reduced left ventricular ejection fraction (LVEF).

Methods

Patients with primary or secondary MR and LVEF <50% who underwent MV replacement or repair (with/without atrial septal defect closure and/or atrial fibrillation ablation) between 2005 and 2017 at our center were retrospectively analyzed using unadjusted and propensity score matching techniques (42 pairs).

Results

A total of 356 patients with either primary (n = 162 [45.5%]) or secondary MR (n = 194 [54.5%]) and LVEF <50% underwent MV repair (n = 293 [82.3%]) or replacement (n = 63 [17.7%]) during the study period. In-hospital mortality was 0.3% (repair) and 1.6% (replacement) in the unmatched cohort (P = .32); there were no in-hospital deaths after matching. Estimated survival was 72.8% (repair) versus 50.1% (replacement) at 8 years in the unmatched (P < .001), and 64.3% (repair) versus 50.7% (replacement) in the matched groups (P = .028). Eight-year cumulative incidence of reoperation was 7.0% and 11.6% in unmatched (P = .28), and 9.9% and 12.7% in matched (P = .69) repair and replacement groups, respectively. Markedly reduced LVEF (<40%) was among the independent predictors of long-term mortality (hazard ratio, 1.7; 95% CI, 1.2-2.4; P = .002). In secondary MR, MV repair showed an 8-year survival benefit over replacement (65.1% vs 44.6%; P = .002), with no difference in reoperation rate (11.6% [repair] vs 17.0% [replacement]; P = .11).

Conclusions

MV repair performed in primary or secondary MR and reduced LVEF provides superior long-term results compared with replacement. Severe LV dysfunction is a significant predictor of reduced survival following MV surgery.