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Thorac Cardiovasc Surg
DOI: 10.1055/a-2266-7677
Original Cardiovascular

Early and Late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience

Julia Götte
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Armin Zittermann 
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Marcus-Andre Deutsch
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Rene Schramm
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Sabine Bleiziffer
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Andre Renner
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
,
Jan F. Gummert
1   Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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Abstract

Background Surgical mitral valve repair is the gold standard treatment of severe primary mitral regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data are essential to support heart-team-based decision-making.

Methods This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve (MV) repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided minithoracotomy (minimally invasive cardiac [MIC] surgery).

Results Of the surgeries (mean age: 59.9 [standard deviation:11.4] years; 71.5% males), 85.6% (n = 1,527) were minithoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation, and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and rethoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was > 99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (p = 0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long-term survival was similar between groups (p = 0.21). In the FS and MIC groups, 1-, 5-, and 10-year survival rates were 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively.

Conclusion MV surgery, both minimally invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.

Keywords

heart - valve - surgery - minimally invasive surgery - reoperation - mitral valve

Supplementary Material



Publication History

Received: 08 January 2023

Accepted: 09 February 2024

Accepted Manuscript online:
12 February 2024

Article published online:
16 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Iung B, Baron G, Butchart EG. et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003; 24 (13) 1231-1243
    CrossrefPubMedGoogle Scholar
  • 2 Jones EC, Devereux RB, Roman MJ. et al. Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). Am J Cardiol 2001; 87 (03) 298-304
    CrossrefPubMedGoogle Scholar
  • 3 Baumgartner H, Falk V, Bax JJ. et al; ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
    CrossrefPubMedGoogle Scholar
  • 4 O'Gara PT, Grayburn PA, Badhwar V. et al. 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70 (19) 2421-2449
    PubMedGoogle Scholar
  • 5 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 1995; 91: 1022-1028
    PubMedGoogle Scholar
  • 6 Chakravarty T, Makar M, Patel D. et al. Transcatheter edge-to-edge mitral valve repair with the MitraClip G4 system. JACC Cardiovasc Interv 2020; 13 (20) 2402-2414
    CrossrefPubMedGoogle Scholar
  • 7 Medicine UNLo. Percutaneous or Surgical Mitral Valve Repair (PRIMARY). Vol 20222021. Accessed May 1, 2022, at: https://clinicaltrials.gov/ct2/show/NCT05051033
    PubMed
  • 8 Medicine UNLo. MitraClip REPAIR MR Study. Vol 20222019. Accessed May 1, 2022, at: https://clinicaltrials.gov/ct2/show/NCT04198870
    PubMed
  • 9 Beckmann A, Meyer R, Lewandowski J, Markewitz A, Blaßfeld D, Böning A. German Heart Surgery Report 2022: the Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2023; 71 (05) 340-355
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Badhwar V, Chikwe J, Gillinov AM. et al. Risk of surgical mitral valve repair for primary mitral regurgitation. J Am Coll Cardiol 2023; 81 (07) 636-648
    CrossrefPubMedGoogle Scholar
  • 11 Abt BG, Bowdish ME, Elsayed RS. et al. Contemporary outcomes of mitral valve repair for degenerative disease in the era of increased penetrance of percutaneous mitral valve technology. JTCVS Open 2022; 13: 106-116
    CrossrefPubMedGoogle Scholar
  • 12 David TE, David CM, Tsang W, Lafreniere-Roula M, Manlhiot C. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse. J Am Coll Cardiol 2019; 74 (08) 1044-1053
    CrossrefPubMedGoogle Scholar
  • 13 Arghami A, Jahanian S, Daly RC. et al. Robotic mitral valve repair: a decade of experience with echocardiographic follow-up. Ann Thorac Surg 2022; 114 (05) 1587-1595
    CrossrefPubMedGoogle Scholar
  • 14 Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Gummert JF. Early and mid-term clinical outcome in younger and elderly patients undergoing mitral valve repair with or without tricuspid valve repair. Interact Cardiovasc Thorac Surg 2015; 20 (01) 85-89
    CrossrefPubMedGoogle Scholar
  • 15 Schwetz V, Scharnagl H, Trummer C. et al. Vitamin D supplementation and lipoprotein metabolism: a randomized controlled trial. J Clin Lipidol 2018; 12 (03) 588-596.e4
    CrossrefPubMedGoogle Scholar
  • 16 David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Circulation 2013; 127 (14) 1485-1492
    CrossrefPubMedGoogle Scholar
  • 17 Götte J, Zittermann A, Hakim-Meibodi K. et al. Long-term clinical outcome in elderly patients undergoing mitral valve repair. Thorac Cardiovasc Surg 2022; 70 (02) 93-99
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Newell P, Percy E, Hirji S. et al. Outcomes of mitral valve repair among high- and low-volume surgeons within a high-volume institution. Ann Thorac Surg 2023; 115 (02) 412-419
    CrossrefPubMedGoogle Scholar
  • 19 Badhwar V, Vemulapalli S, Mack MA. et al. Volume-outcome association of mitral valve surgery in the United States. JAMA Cardiol 2020; 5 (10) 1092-1101
    CrossrefPubMedGoogle Scholar
  • 20 Chikwe J, Toyoda N, Anyanwu AC. et al. Relation of mitral valve surgery volume to repair rate, durability, and survival. J Am Coll Cardiol 2017; S0735-1097 (17)30677-0
    PubMedGoogle Scholar
  • 21 Makkar RR, Chikwe J, Chakravarty T. et al. Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA 2023; 329 (20) 1778-1788
    CrossrefPubMedGoogle Scholar
  • 22 Feldman T, Kar S, Elmariah S. et al; EVEREST II Investigators. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol 2015; 66 (25) 2844-2854
    CrossrefPubMedGoogle Scholar
  • 23 McCarthy PM, Whisenant B, Asgar AW. et al. Percutaneous MitraClip device or surgical mitral valve repair in patients with primary mitral regurgitation who are candidates for surgery: design and rationale of the REPAIR MR trial. J Am Heart Assoc 2023; 12 (04) e027504
    CrossrefPubMedGoogle Scholar
  • 24 Chikwe J, O'Gara P, Fremes S. et al. Mitral surgery after transcatheter edge-to-edge repair: Society of Thoracic Surgeons database analysis. J Am Coll Cardiol 2021; 78 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 25 Gammie JS, Chikwe J, Badhwar V. et al. Isolated mitral valve surgery: the Society of Thoracic Surgeons adult cardiac surgery database analysis. Ann Thorac Surg 2018; 106 (03) 716-727
    CrossrefPubMedGoogle Scholar
  • 26 Tatum JM, Bowdish ME, Mack WJ. et al. Outcomes after mitral valve repair: a single-center 16-year experience. J Thorac Cardiovasc Surg 2017; 154 (03) 822-830.e2
    CrossrefPubMedGoogle Scholar
  • 27 Roach A, Trento A, Emerson D. et al. Durable robotic mitral repair of degenerative primary regurgitation with long-term follow-up. Ann Thorac Surg 2022; 114 (01) 84-90
    CrossrefPubMedGoogle Scholar