Key result
Recurrent MR after degenerative mitral valve repair is linked to ~72% higher mortality.
Why the study?
The risk for and consequences of recurrent mitral regurgitation following degenerative mitral valve repair are poorly understood, motivating an examination of recurrent MR risk, reoperation, and survival rates.
What is the risk of recurrent mitral regurgitation and its effect on reoperation and survival in patients undergoing primary mitral valve repair for isolated degenerative mitral regurgitation?
Cohort (n=1,218)
What is the risk of recurrent mitral regurgitation and its effect on reoperation and survival in patients undergoing primary mitral valve repair for isolated degenerative mitral regurgitation?
Recurrent mitral regurgitation following degenerative mitral valve repair occurs at a 15-year incidence of 13.3% (decreasing markedly after the first year) and is independently associated with adverse left ventricular remodeling and late mortality.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Thus, less than complete eradication of MR, due to leaflet anatomy, extent and severity of myxomatous changes, and technical factors, creates the substrate for progression to more severe MR over many years following surgery, with its associated impact on the left ventricle and patient longevity.”
MR recurrence after mitral repair signals higher mortality risk; leaves open whether preventing recurrence improves survival.
Background The risk for and consequences of recurrent mitral regurgitation (MR) following degenerative mitral valve repair are poorly understood. Objectives This study sought to examine recurrent MR risk along with reoperation and survival rates. Methods We evaluated patients undergoing primary mitral repair for isolated degenerative MR over 1 decade. Median follow-up was 11.5 years (interquartile range: 9.2 to 13.6 years) and was 99% complete. Multivariate analysis of post-repair MR recurrence employed Cox proportional hazards and multistate modeling. Results A total of 1,218 patients met the study criteria; the mean age was 64 ± 13 years, mean ejection fraction was 63 ± 9%, and 864 (71%) patients were men. Prolapse was posterior in 62%, bileaflet in 26%, and anterior in 12%. The 15-year incidence of recurrent MR (i.e., MR ≥2) was 13.3%, incidence of mitral reoperation was 6.9%, and overall mortality was 44.0%. Repair before 1996 independently predicted MR recurrence (hazard ratio: 1.52). Additional determinants were: age, mild intraoperative residual MR, anterior leaflet prolapse, bileaflet prolapse, perfusion time >90 min, and lack of annuloplasty. Recurrence of moderate or greater MR was associated with adverse left ventricular remodeling and increased likelihood of death (hazard ratio: 1.72). Among those undergoing repair after 1996, MR recurrence rate was 1.5 per 100 patient-years during the first year post-repair, decreasing markedly to 0.9 thereafter. Conclusions Our study demonstrated that recurrent MR following degenerative mitral valve repair is associated with adverse left ventricular remodeling and late death. The incidence of MR recurrence decreases markedly following the first year after intervention. A transparent discussion of recurrent MR risk has pressing relevance when referring patients with complex mitral valve prolapse.
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Suri et al. (2016) conducted a cohort in Isolated degenerative mitral regurgitation undergoing primary mitral valve repair (n=1,218). Recurrent moderate or greater mitral regurgitation (MR ≥2) following degenerative mitral valve repair vs. No recurrent moderate or greater mitral regurgitation was evaluated on Recurrent mitral regurgitation (MR ≥2), mitral reoperation, and overall mortality (HR 1.72). Recurrent moderate or greater MR after degenerative mitral valve repair occurred in 13.3% at 15 years and was associated with increased likelihood of death (HR 1.72) and adverse LV remodeling.
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