After a 5-year follow-up, would you repair the mitral valve or replace it?

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 analyze the clinical results and identify risk factors for short and long-term mortality. Methods: In a single-center analysis, patients undergoing isolated mitral valve procedures 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 the adequate statistical tool, identifying risk factors for the investigated endpoints. Results: 241 patients were identified in the entire cohort. After matching, patients were divided into 2 groups of 64 in each. The median age was similar. There was significant interaction to 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). 5-year survival was significantly higher in MVRe versus MVRp (90.06% vs. 79.54% respectively, P=0.04). 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 rehospitalization 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.