Functional Mitral Valve Regurgitation: Mitral Valve Repair or Replacement? Our “Road Map” for the Appropriate Strategy

Background: After years of debate about the optimal surgical approach for the treatment of functional mitral regurgitation, current guidelines suggest that the approach has to be tailored to the individual patient. The aim of the present study was to clarify further aspects of this tailored treatment.

Methods: A total of 390 patients who underwent mitral valve (MV) surgery at our institution due to functional mitral regurgitation were included in the present study. To identify patients, who potentially benefit more from a mitral valve repair, we analyzed the effect of the surgical approach (MV repair or replacement) on survival by dividing both procedures into age groups and then comparing potential risk factors. Patients were divided into the age groups < 65 years, 65–75 years, and > 75 years, and each age group was further divided into ischemic or nonischemic origin of FMR, LV function, LV remodeling grade and current heart rhythm.

Results: Overall survival rates for the repair group at 1-, 5-, and 8-years were 86.1 ± 1.9%, 70.6 ± 2.6%, and 55.1 ± 3.1%, respectively. For the same intervals, the survival rates in patients who underwent mitral valve replacement were 75.9 ± 4.5, 58.6 ± 5.4, and 40.9 ± 6.4%, respectively (p = 0.003). Patients younger than 65 years, with an ischemic etiology of FMR, poor Ejection Fraction, severe dilatation of left ventricle, and presence of atrial fibrillation had a significantly higher mortality risk if they underwent MV replacement. In this age group the risk of death is 3-fold higher receiving a mitral valve replacement (HR, 3.0; CI, 1.3–6.9; p = 0.007). Elderly patients (65–75 years) had a higher risk of death when undergoing mitral valve replacement (HR, 1.7; CI, 1.0–2.8; p = 0.04). In patients older than 75 years, the surgical approach (MV repair or replacement) had no effect on postoperative survival (HR, 0.8; CI, 0.4–1.3; p = 0.4).

Conclusion: The tailored treatment of functional mitral regurgitation should always intend a mitral valve repair in patients younger than 65 years. Our results demonstrated an advantage of MV repair over replacement in younger patients with functional MR. This advantage was even more evident in younger patients with an ischemic origin of MR, poor ejection fraction, severe LV remodeling, and presence of atrial fibrillation.

 

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Die Autoren geben an, dass kein Interessenkonflikt besteht.

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Artikel online veröffentlicht:
13. Februar 2024