Key result
Mitral valve repair shows comparable in-hospital mortality to replacement in degenerative disease with LVEF <30%.
Why the study?
To compare early postoperative outcomes between mitral valve repair and replacement in patients with degenerative mitral valve disease and poor preoperative LVEF.
Does mitral valve repair improve in-hospital mortality compared to mitral valve replacement in patients with degenerative mitral valve disease and LVEF <30%?
Observational (n=1,138)
Yes
Does mitral valve repair improve in-hospital mortality compared to mitral valve replacement in patients with degenerative mitral valve disease and LVEF <30%?
Odds Ratio: 0.64 (95% CI 0.39–1.05)
Absolute Event Rate: 8.5% vs 13%
p-value: p=0.080
In patients with degenerative mitral valve disease and severely reduced LVEF, mitral valve repair demonstrates comparable early mortality and morbidity to replacement after multivariable adjustment.
Repair and replacement show comparable in-hospital mortality; observational data leaves open optimal strategy in degenerative disease with LVEF <30%.
Objectives To compare early postoperative outcomes between mitral valve repair (MVr) and replacement (MVR) in patients with degenerative mitral valve disease (DMVD) and poor preoperative left ventricular ejection fraction (LVEF). Methods A retrospective propensity-score matched analysis of 1,138 patients (612 MVr, 526 MVR) undergoing mitral valve surgery for DMVD with LVEF <30% between 2000–2019 was undertaken using the UK National Adult Cardiac Surgery Audit. The primary outcome was in-hospital mortality; secondary outcomes included stroke, postoperative dialysis, re-exploration for bleeding and length of stay >10 days. Binary logistic regression was conducted to further examine the relationship between procedure and outcomes. Results In unadjusted analyses, MVr demonstrated lower in-hospital mortality (7.2% vs 17.1%, p < 0.001), postoperative dialysis (7.2% vs 14.1%, p < 0.001), and prolonged hospital stay (54.5% vs 67.1%, p < 0.001). After propensity matching, unadjusted outcomes continued to favour MVr for mortality (8.5% vs 13.0%, p = 0.040) and dialysis (8.3% vs 12.8%, p = 0.038). However, multivariable adjustment demonstrated no significant difference in mortality (OR = 0.64, 95% CI 0.39–1.05, p = 0.080) or major morbidity between techniques. Independent predictors of mortality included emergency surgery, concomitant aortic valve surgery, peripheral vascular disease, and redo sternotomy. Conclusions In patients with DMVD and severely reduced LVEF, MVr demonstrated comparable early mortality and morbidity to MVR after adjustment. These findings suggest that mitral valve repair is safe and feasible in this higher-risk population when appropriate surgical expertise and careful patient selection are applied. Further investigation with larger cohorts and long-term follow-up is needed to assess durability and functional outcomes.
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Al-Zubaidi et al. (2026) conducted an observational in Degenerative mitral valve disease with LVEF <30% (n=1,138). Mitral valve repair vs. Mitral valve replacement was evaluated on In-hospital mortality (OR 0.64, 95% CI 0.39-1.05, p=0.080). Mitral valve repair demonstrated comparable in-hospital mortality to replacement in patients with degenerative mitral valve disease and LVEF <30% after adjustment (OR 0.64; 95% CI 0.39-1.05; p=0.080).
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