Key result
Mitral valve repair was associated with a significantly higher 5-year survival rate (90.06%) compared to mitral valve replacement (79.54%) in patients with mitral valve regurgitation.
Why the study?
Mitral valve repair is considered superior to replacement in mitral regurgitation, but further analysis of clinical outcomes and risk factors for short- and long-term mortality was needed.
Does mitral valve repair improve 5-year survival compared to mitral valve replacement in patients with moderate to severe mitral valve regurgitation?
Cohort (n=128)
No
Does mitral valve repair improve 5-year survival compared to mitral valve replacement in patients with moderate to severe mitral valve regurgitation?
Absolute Event Rate: 90.06% vs 79.54%
p-value: p=0.04
Mitral valve repair is associated with significantly lower 5-year mortality compared to mitral valve replacement in patients with moderate to severe mitral regurgitation.
Supports repair preference in observational data; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Mitral valve repair (MVRe) is considered to have a superior outcome compared to replacement (MVRp) in patients with mitral valve regurgitation (MVR). It was the aim of the study to analyse the clinical results and identify risk factors for short and long-term mortality. METHODS: In a retrospective single-center analysis, patients undergoing an isolated mitral valve procedure from June 2010 to December 2016 were identified. These were subsequently homogenized using 10 baseline characteristics for propensity-score matching. Comparative analyses were performed for early and long-term results, using adequate statistical tools, and identifying risk factors for the investigated endpoints, primary end-point: all-cause mortality within 5 years and secondary end-points: recurrent MVR, reoperation, endocarditis and/or mortality with 30 days, 1, 3 and 5 years. RESULTS: 241 patients were identified in the entire patient cohort. After matching, patients were divided into 2 groups of 64 each respectively. The median age was similar in the two groups. There was a significant interaction between early mortality risk of MV in patients with coronary artery disease (CAD) (OR 11.94, 95% CI 1.49-285.92, p = 0.04) and late mortality in patients with higher EuroSCORE II (HR 1.14, 95% CI 1.06-1.23, p < 0.001). The primary end-point showed 5-year survival rate was significantly higher in MVRe versus MVRp (90.06% vs. 79.54% respectively, p = 0.04). The secondary end-point demonstrated recurrent MVR not to be statistically significant between the 2 groups (p = 0.09) as well as reoperation (p = 0.28). Endocarditis was observed in one patient after MVRp. CONCLUSIONS: We concluded MVRe to be associated with lower operative and 5-year mortality and good postoperative outcomes compared to patients undergoing MVRp. Concomitant CAD was identified as one of the risk factors for increasing the in-hospital mortality rate. There was no significant difference in rehospitalisation over the follow-up period. MVRe should be the treatment of choice for severe MVR and should remain a central aspect in valve centers' treatment algorithms and quality measures.
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Laham et al. (2023) conducted a cohort in Mitral valve regurgitation (n=128). Mitral valve repair vs. Mitral valve replacement was evaluated on 5-year survival rate (p=0.04). Mitral valve repair was associated with a significantly higher 5-year survival rate (90.06%) compared to mitral valve replacement (79.54%) in patients with mitral valve regurgitation.
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