Isolated Mitral Valve Repair in Patients with Reduced Left Ventricular Function

Objectives: This study analyzed the clinical outcomes after isolated mitral valve repair in patients with reduced left ventricular function according to the stratification in current heart failure guidelines with special focus on early postoperative characteristics, mid-/long-term survival and freedom from reoperations.

Methods: Within 19 years a total of 4,178 patients underwent isolated mitral valve repair for mitral regurgitation at our institution. Among them, 557 patients (13.3%) presented reduced left ventricular function. They were classified into four different sub-groups: left ventricular ejection fraction 40 to 49% (group 1), 35 to 39% (group 2), 30 to 34% (group 3), and < 30% (group 4). Primary endpoint was mid-/long-term survival and freedom from reoperation. Periprocedural characteristics were the secondary endpoint. Kaplan–Meier analysis, logrank test, chi square and Fisher’s exact tests were performed to determine clinical outcomes.

Results: Perioperative variables and postoperative complications were similar among the 4 groups. Subgroup analysis showed a significant increase in the 30-day mortality, as well as a significant decrease in the 1-, 5-, and 10-year survival as the left ventricular ejection fraction lowered (p < 0.001). Freedom from reoperation at 5 and 10 years was significantly lower as the left ventricular function decreased (p < 0.001).

Conclusions: Mitral valve repair can be performed with low operative mortality and good mid- and long-term results in patients with heart failure. It should even be considered as an alternative for patients who are being evaluated for transcatheter therapy. Perioperative risk increases as the left ventricular ejection fraction decreases.

This abstract has also been submitted and accepted for oral presentation in the 32nd EACTS Annual Meeting in Milan, Italy, October 18 to 20, 2018.