Key result
Mitral valve surgery linked to ~64% lower apnea-hypopnea index in severe primary MR.
Why the study?
The prevalence and relationship between sleep disordered breathing and severe primary mitral regurgitation had not been well investigated.
Does mitral valve surgery improve sleep disordered breathing in patients with severe primary mitral regurgitation?
Cohort (n=121)
Does mitral valve surgery improve sleep disordered breathing in patients with severe primary mitral regurgitation?
Absolute Event Rate: 4% vs 11%
p-value: p=0.04
Mitral valve surgery significantly reduces the severity of sleep disordered breathing in patients with severe primary mitral regurgitation, highlighting a bidirectional relationship between SDB and cardiac hemodynamics.
May inform preoperative SDB risk assessment in severe primary MR; leaves open causal benefit in randomized trials.
Background: Sleep disordered breathing (SDB) is a frequent comorbidity in cardiac disease patients. Nevertheless, the prevalence and relationship between SDB and severe primary mitral regurgitation (PMR) has not been well investigated to date. Methods: A cohort of 121 patients with significant PMR undergoing mitral valve surgery were prospectively enrolled and received a cardiorespiratory single night polygraphy screening using ApneaLink before surgery. Eighty-two of them underwent a follow-up examination including a follow-up single-night sleep study 3 months after surgery. Results: The mean age of patients was 65.3 ± 12.0 years. Sixty patients (49.6%) were female. The mean EuroSCORE II was 2.5 ± 2.4%. Initially, 91 (75.2%) patients presented with SDB, among whom 50.4% (46 patients, 38.0% of total cohort) were classified as moderate to severe. These patients tended to require significantly longer postoperative intensive care and mechanical ventilation. Among the 82 patients who completed follow-up exams, mitral valve surgery led to a significant reduction in relevant SDB (20.7%). The apnea-hypopnea index (from 11/h [4;18] to 4/h [3;14] (p = 0.04)), the oxygenation-desaturation index (from 8/h [3;18] to 5/h [3;12] (p = 0.008)) as well as the saturation time below 90% (from 32 min [13;86] to 18 min [5;36] (p = 0.005)), were all shown to be improved significantly. Conclusion: The prevalence of SDB is very high in patients with severe primary mitral regurgitation and may contribute to postoperative complications and prolonged intensive care. A significantly reduced but still high prevalence of SDB was observed 3 months after mitral valve surgery, highlighting the bidirectional relationship between SDB and heart failure.
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Gerçek et al. (2021) conducted a cohort in Primary mitral regurgitation (n=121). Mitral valve surgery vs. Baseline (pre-surgery) was evaluated on Apnea-hypopnea index (p=0.04). Mitral valve surgery significantly reduced the apnea-hypopnea index from 11/h to 4/h (p=0.04) at 3 months in patients with severe primary mitral regurgitation.
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