TY - JOUR
T1 - Long-Term Results of Mitral Valve Repair for Regurgitation Due to Leaflet Prolapse
AU - David, Tirone E.
AU - David, Carolyn M.
AU - Tsang, W.
AU - Lafreniere-Roula, Myriam
AU - Manlhiot, Cedric
N1 - Funding Information:
The authors are indebted to the cardiologists from University Health Network and outside institutions for continuously providing clinical and echocardiographic information regarding the patients included in this study during the past 3 decades. This clinical research project was funded by the Academic Enrichment Fund of the Division of Cardiovascular Surgery of Toronto General Hospital. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/8/27
Y1 - 2019/8/27
N2 - Background: Mitral valve (MV) repair has become the standard therapy for mitral regurgitation (MR) due to degenerative diseases, but information on late outcomes is limited. Objectives: The purpose of this study was to examine the late results of MV repair for MR in a large cohort of patients. Methods: A total of 1,234 consecutive patients (median age 59 years; 70.4% men) had MV repair for MR due to leaflet prolapse and were followed prospectively for a median of 13 years (interquartile range: 8 to 34 years) with periodical echocardiographic studies. There were 163 patients still at risk at 20 years. Cumulative incidences of adverse events and associated factors were examined with death as a competing outcome. Results: At 20 years, reoperation-free survival was 60.4% (95% confidence interval: 56.2% to 64.2%) and the cumulative incidence of cardiac and valve-related deaths was 12%, noncardiac deaths 21.3%, reoperation on the MV 4.6%, infective endocarditis 1.1%, thromboembolism 10.3%, and bleeding 6.4%. The probability of recurrent moderate or severe MR was 12.5%, persistent or new moderate or severe tricuspid regurgitation (TR) 20.8%, and new atrial fibrillation (AF) 32.4%. Multivariable analysis identified older age, complete heart block, MV repair without annuloplasty ring, and the degree of myxomatous degeneration of the MV to be associated with recurrent MR. The development of AF and TR was unrelated to recurrent MR. Conclusions: MV reoperation was uncommon after MV repair, but there was an increasing incidence of recurrent MR, TR, and new AF over time.
AB - Background: Mitral valve (MV) repair has become the standard therapy for mitral regurgitation (MR) due to degenerative diseases, but information on late outcomes is limited. Objectives: The purpose of this study was to examine the late results of MV repair for MR in a large cohort of patients. Methods: A total of 1,234 consecutive patients (median age 59 years; 70.4% men) had MV repair for MR due to leaflet prolapse and were followed prospectively for a median of 13 years (interquartile range: 8 to 34 years) with periodical echocardiographic studies. There were 163 patients still at risk at 20 years. Cumulative incidences of adverse events and associated factors were examined with death as a competing outcome. Results: At 20 years, reoperation-free survival was 60.4% (95% confidence interval: 56.2% to 64.2%) and the cumulative incidence of cardiac and valve-related deaths was 12%, noncardiac deaths 21.3%, reoperation on the MV 4.6%, infective endocarditis 1.1%, thromboembolism 10.3%, and bleeding 6.4%. The probability of recurrent moderate or severe MR was 12.5%, persistent or new moderate or severe tricuspid regurgitation (TR) 20.8%, and new atrial fibrillation (AF) 32.4%. Multivariable analysis identified older age, complete heart block, MV repair without annuloplasty ring, and the degree of myxomatous degeneration of the MV to be associated with recurrent MR. The development of AF and TR was unrelated to recurrent MR. Conclusions: MV reoperation was uncommon after MV repair, but there was an increasing incidence of recurrent MR, TR, and new AF over time.
KW - degenerative diseases of the mitral valve
KW - mitral regurgitation
KW - mitral valve repair
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U2 - 10.1016/j.jacc.2019.06.052
DO - 10.1016/j.jacc.2019.06.052
M3 - Article
C2 - 31439213
AN - SCOPUS:85070490009
SN - 0735-1097
VL - 74
SP - 1044
EP - 1053
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -