Short- and mid-term outcomes of mitral valve repair vs. replacement in degenerative mitral regurgitation with left ventricular enlargement

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Degenerative mitral regurgitation with left ventricular dilatation (n=150). Intervention: Mitral valve repair vs. Mitral valve replacement. Primary outcome: All-cause mortality (p=0.497).

Q: What does this research mean for the field?

In patients with degenerative mitral regurgitation and severe left ventricular dilatation, mitral valve repair yields comparable short- to mid-term all-cause survival to mitral valve replacement while better preserving subclinical left ventricular systolic function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chun Wu; Zhe Sheng; 健昊 胡; Yuyong Liu; Chengxin Zhang; Jinguo Xu

doi:10.3389/fcvm.2026.1944441

September 25, 2026Frontiers in Cardiovascular MedicineOpen Access

Short- and mid-term outcomes of mitral valve repair vs. replacement in degenerative mitral regurgitation with left ventricular enlargement

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Key result

Mitral valve repair resulted in comparable postoperative all-cause survival compared to replacement in patients with degenerative mitral regurgitation and severe left ventricular dilatation (log-rank P=0.497).

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Why the study?

Short- to mid-term outcomes following mitral valve repair versus replacement in patients with degenerative mitral regurgitation and substantial left ventricular dilatation were not well characterized.

Does mitral valve repair improve survival and reduce complications compared to mitral valve replacement in patients with degenerative mitral regurgitation and advanced left ventricular enlargement?

Key Points

To evaluate short- to mid-term clinical outcomes and myocardial function following mitral valve repair versus replacement in degenerative mitral regurgitation with marked left ventricular dilatation.
Retrospective analysis of 150 patients with degenerative mitral regurgitation and severe left ventricular dilatation who underwent mitral valve replacement (n=85, 56.67%) or repair (n=65, 43.33%).
Applied 1:1 propensity score matching (n=36 per group; 72 total) to balance baseline covariates, with an overall median follow-up of 55.5 (21.0) months.
Kaplan–Meier survival curves showed equivalent postoperative survival between repair and replacement cohorts before matching (log-rank P = 0.175) and after matching (log-rank P = 0.497).
Mitral valve repair preserved subclinical systolic function better than replacement, showing significant differences in postoperative left ventricular ejection fraction (P = 0.005) and global longitudinal strain (P = 0.023).
Major bleeding occurred exclusively with replacement (10.39% pre-matching, P = 0.020; 18.75% post-matching, P = 0.024), whereas recurrent regurgitation was significantly higher with repair (P = 0.017), resulting in two reoperations.

Study Design

Type

Cohort (n=150)

Blinding

Open-label

Multicenter

No

Structured PICO

Does mitral valve repair improve survival and reduce complications compared to mitral valve replacement in patients with degenerative mitral regurgitation and advanced left ventricular enlargement?

P

Population

150 patients with degenerative mitral regurgitation and severe left ventricular dilatation (≥6.0 cm) who underwent either mitral valve repair or replacement, followed for a median of 55.5 months.

E

Exposure

Mitral valve repair (MVP) tailored to underlying leaflet pathology (e.g., leaflet resection, artificial chordae tendineae implantation, commissural closure, and prosthetic annuloplasty) determined intraoperatively based on anatomical feasibility.

C

Comparator

Mitral valve replacement (MVR) using either mechanical (65.88%) or bioprosthetic (34.12%) valves with preservation of the subvalvular apparatus when feasible, followed by appropriate anticoagulation therapy.

O

Outcome

All-cause mortality at a median clinical follow-up of 55.5 months.hard clinical

Main Result

p-value: p=0.497

In patients with severe degenerative mitral regurgitation and marked left ventricular dilation, mitral valve repair and replacement provide equivalent mid-term survival, though repair offers better preservation of subclinical LV systolic function at the cost of a higher risk of recurrent regurgitation.

Limitations

Modest sample size from a single center
Lack of stratification according to age, prolapse location, and left ventricular size
Baseline global longitudinal strain and specific location of leaflet prolapse were not incorporated into the propensity score matching model
Limited sample size and number of events during long-term follow-up reduced statistical power
Follow-up echocardiographic parameters were obtained from the most recent available outpatient echocardiogram rather than at a predefined postoperative time point
Modest sample size and lack of stratification according to important clinical and anatomical characteristics (e.g., age, prolapse location).
Baseline GLS and specific location of leaflet prolapse were not incorporated into the propensity score matching model.
Limited sample size and number of events during long-term follow-up reduced statistical power.
Follow-up echocardiographic parameters were obtained from the most recent outpatient visit rather than at predefined fixed time points.

Implication

Comparable survival with repair or replacement; leaves open optimal strategy pending randomized trials on LV function versus regurgitation recurrence.

Abstract

Objective This study evaluates short- to mid-term outcomes following mitral valve repair (MVP) and mitral valve replacement (MVR) among patients with degenerative mitral regurgitation (DMR) complicated by substantial left ventricular dilatation (LVD). Methods We performed a retrospective analysis enrolling 150 patients diagnosed with DMR and severe LVD who received either MVP or MVR. The median clinical follow-up duration was 55.5 (21.0) months. Propensity score matching (PSM) was conducted to eliminate intergroup baseline disparities. Kaplan–Meier survival curves were generated to estimate short- and mid-term all-cause survival. Results Of the 150 enrolled patients with DMR and marked left ventricular dilatation, 56.67% underwent MVR and 43.33% received MVP. The cohort had a median age of 59 (17) years, with female patients making up 23.3% of participants. Preoperative atrial fibrillation occurred in 15.33% of patients, and 92.05% presented with severe baseline mitral valve regurgitation (MR). Analyses before and after PSM showed similar postoperative left ventricular end-diastolic dimension (LVEDD) and New York Heart Association functional class across groups. Significant intergroup differences were detected in postoperative MR ( P = 0.017), left ventricular ejection fraction (LVEF) ( P = 0.005), and global longitudinal strain (GLS) ( P = 0.023). Kaplan–Meier curves indicated equivalent postoperative survival for patients who underwent MVP and MVR both before matching (log-rank P = 0.175) and after PSM matching (log-rank P = 0.497). Conclusions In patients with DMR and dilated left ventricles (≥6.0 cm), MVR was associated with a greater incidence of postoperative hemorrhage related to long-term oral anticoagulation, whereas MVP conferred a higher risk of recurrent MR. Postoperative mortality was comparable across cohorts; however, preserved left ventricular subclinical systolic function (GLS and LVEF) in the MVP group suggests potential long-term myocardial benefits, which warrants further prospective investigation.

Discussion

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Cite This Study

Wu et al. (2026) conducted a cohort in Degenerative mitral regurgitation with left ventricular dilatation (n=150). Mitral valve repair vs. Mitral valve replacement was evaluated on All-cause mortality (p=0.497). Mitral valve repair resulted in comparable postoperative all-cause survival compared to replacement in patients with degenerative mitral regurgitation and severe left ventricular dilatation (log-rank P=0.497).

synapsesocial.com/papers/6ad0fd553afa093ea9ad0411 https://doi.org/10.3389/fcvm.2026.1944441

Topics

Persistent AF management

Atrial fibrillation

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Short- and mid-term outcomes of mitral valve repair vs. replacement in degenerative mitral regurgitation with left ventricular enlargement

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Short- and mid-term outcomes of mitral valve repair vs. replacement in degenerative mitral regurgitation with left ventricular enlargement

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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