September 18, 2001
View Full PaperVery Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse
Key Result
Mitral valve repair for severe mitral regurgitation was associated with lower mortality than replacement for both posterior (RR 0.61; 95% CI 0.44-0.85) and anterior (RR 0.67) leaflet prolapse.
Study Design
Type
Cohort (n=917)
Structured PICO
Does mitral valve repair improve very long-term survival compared to mitral valve replacement in patients with severe mitral regurgitation due to mitral valve prolapse?
P
Population
917 patients (mean age 65, 32% female) with severe isolated mitral regurgitation due to mitral valve prolapse who underwent surgical correction between 1980 and 1995, followed for >10 years.
E
Exposure
Mitral valve repair (n=679)
C
Comparator
Mitral valve replacement (MVR) (n=238)
O
Outcome
Very long-term survival (mortality)hard clinical
Mitral valve repair provides superior very long-term survival compared to replacement for severe mitral regurgitation due to both anterior and posterior leaflet prolapse, with similar overall reoperation rates.
Main Result
Relative Risk: 0.61 (95% CI 0.44–0.85)
p-value: p=0.0034
Abstract
Background Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is often treatable by surgical repair. However, the very long-term (>10-year) durability of repair in both anterior leaflet prolapse (AL-MVP) and posterior leaflet prolapse (PL-MVP) is unknown. Methods and Results In 917 patients (aged 65±13 years, 68% male), surgical correction of severe isolated MR due to MVP (679 repairs and 238 replacements MVRs) was performed between 1980 and 1995. Survival after repair was better than survival after MVR for both PL-MVP (at 15 years, 41±5% versus 31±6%, respectively; P =0.0003) and AL-MVP (at 14 years, 42±8% versus 31±5%, respectively; P =0.003). In multivariate analysis adjusting for predictors of survival, repair was independently associated with lower mortality in PL-MVP (adjusted risk ratio RR 0.61, 95% CI 0.44 to 0.85; P =0.0034) and in AL-MVP (adjusted RR 0.67, 95% CI 0.47 to 0.96; P =0.028). The reoperation rate was not different after repair or MVR overall (at 19 years, 20±5% for repair versus 23±5% for MVR; P =0.4) or separately in PL-MVP ( P =0.3) or AL-MVP ( P =0.3). However, the reoperation rate was higher after repair of AL-MVP than after repair of PL-MVP (at 15 years, 28±7% versus 11±3%, respectively; P =0.0006). From the 1980s to the 1990s, the RR of reoperation after repair of AL-MVP versus PL-MVP did not change (RR 2.5 versus 2.7, respectively; P =0.58), but the absolute rate of reoperation decreased similarly in PL-MVP and AL-MVP (at 10 years, from 10±3% to 5±2% and from 24±6% to 10±2%, respectively; P =0.04). Conclusions In severe MR due to MVP, mitral valve repair compared with MVR provides improved very long-term survival after surgery for both AL-MVP and PL-MVP. Reoperation is similarly required after repair or replacement but is more frequent after repair of AL-MVP. Recent improvement in long-term durability of repair suggests that it should be the preferred mode of surgical correction of MVP whether it affects anterior or posterior leaflets and is an additional incentive for early surgery of severe MR due to MVP.