Long-term results of mitral repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: does the technique matter?
Key result
Combining the edge-to-edge technique with annuloplasty significantly reduced the 10-year recurrence of MR ≥3+ compared to isolated annuloplasty (10.3% vs 30.8%, P=0.01), without improving survival.
Why the study?
Does the edge-to-edge technique combined with annuloplasty reduce MR recurrence and improve survival compared to isolated annuloplasty in patients with severe LV dysfunction and secondary MR?
Population
105 consecutive patients with severe left ventricular dysfunction and secondary mitral regurgitation…
Comparison
Edge-to-edge technique combined with annuloplasty. vs Isolated undersized annuloplasty.
Design
Cohort
Follow-up
median 7.2 years (interquartile range 4.3;10.4)
Authors
Discussion
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Implication
May reduce MR recurrence in secondary MR; leaves open survival benefit and need for RCTs in severe LV dysfunction.
Study Design
Type
Cohort (n=105)
Multicenter
No
Structured PICO
Does the edge-to-edge technique combined with annuloplasty reduce MR recurrence and improve survival compared to isolated annuloplasty in patients with severe LV dysfunction and secondary MR?
P
Population
105 consecutive patients with severe left ventricular dysfunction and secondary mitral regurgitation undergoing mitral valve repair, followed for a median of 7.2 years.
E
Exposure
Edge-to-edge (EE) technique combined with annuloplasty (n=65, performed in patients with baseline coaptation depth ≥1 cm).
C
Comparator
Isolated undersized annuloplasty (n=40, performed in patients with baseline coaptation depth <1 cm).
O
Outcome
10-year overall survival and cumulative incidence of recurrence of MR ≥3+.hard clinical
Main Result
Hazard Ratio: 4.84 (95% CI 1.46–16.1)
Absolute Event Rate: 10.3% vs 30.8%
p-value: p=0.01
In patients with end-stage DCM and secondary MR, combining the edge-to-edge technique with undersized annuloplasty significantly decreases long-term MR recurrence compared to annuloplasty alone, though this does not translate into improved long-term survival.
Cite This Study
Bonis et al. (2016) conducted a cohort in Severe left ventricular dysfunction and secondary mitral regurgitation (n=105). Edge-to-edge technique combined with annuloplasty vs. Isolated undersized annuloplasty was evaluated on Recurrence of MR ≥3+ at 10 years (HR 4.84, 95% CI 1.46-16.1, p=0.01). Combining the edge-to-edge technique with annuloplasty significantly reduced the 10-year recurrence of MR ≥3+ compared to isolated annuloplasty (10.3% vs 30.8%, P=0.01), without improving survival.