Mitral valve replacement versus repair for severe mitral regurgitation in patients with reduced left ventricular ejection fractionCentral MessagePerspective
Zara Dietze, MD,
Mateo Marin-Cuartas, MD,
Livia Berkei, MD,
Manuela De La Cuesta, MD,
Wolfgang Otto, MSc,
Bettina Pfannmüller, MD, PhD,
Philipp Kiefer, MD, PhD,
Martin Misfeld, MD, PhD,
Alexey Dashkevich, MD, PhD,
Jagdip Kang, MD,
Sergey Leontyev, MD, PhD,
Michael A. Borger, MD, PhD,
Thilo Noack, MD, PhD,
Marcel Vollroth, MD
Affiliations
Zara Dietze, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Address for reprints: Michael A. Borger, MD, PhD, and Zara Dietze, MD, University Department of Cardiac Surgery, Leipzig Heart Center, Struempellstr 39, Leipzig, 04289, Germany.
Mateo Marin-Cuartas, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Livia Berkei, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Manuela De La Cuesta, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Wolfgang Otto, MSc
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Bettina Pfannmüller, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Philipp Kiefer, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Martin Misfeld, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Alexey Dashkevich, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Jagdip Kang, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Sergey Leontyev, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Michael A. Borger, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Address for reprints: Michael A. Borger, MD, PhD, and Zara Dietze, MD, University Department of Cardiac Surgery, Leipzig Heart Center, Struempellstr 39, Leipzig, 04289, Germany.
Thilo Noack, MD, PhD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Marcel Vollroth, MD
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
Objective: This study compares early and long-term outcomes following mitral valve (MV) repair and replacement in patients with mitral regurgitation (MR) and reduced left ventricular ejection fraction (LVEF). Methods: Patients with primary or secondary MR and LVEF <50% who underwent MV replacement or repair (with/without atrial septal defect closure and/or atrial fibrillation ablation) between 2005 and 2017 at our center were retrospectively analyzed using unadjusted and propensity score matching techniques (42 pairs). Results: A total of 356 patients with either primary (n = 162 [45.5%]) or secondary MR (n = 194 [54.5%]) and LVEF <50% underwent MV repair (n = 293 [82.3%]) or replacement (n = 63 [17.7%]) during the study period. In-hospital mortality was 0.3% (repair) and 1.6% (replacement) in the unmatched cohort (P = .32); there were no in-hospital deaths after matching. Estimated survival was 72.8% (repair) versus 50.1% (replacement) at 8 years in the unmatched (P < .001), and 64.3% (repair) versus 50.7% (replacement) in the matched groups (P = .028). Eight-year cumulative incidence of reoperation was 7.0% and 11.6% in unmatched (P = .28), and 9.9% and 12.7% in matched (P = .69) repair and replacement groups, respectively. Markedly reduced LVEF (<40%) was among the independent predictors of long-term mortality (hazard ratio, 1.7; 95% CI, 1.2-2.4; P = .002). In secondary MR, MV repair showed an 8-year survival benefit over replacement (65.1% vs 44.6%; P = .002), with no difference in reoperation rate (11.6% [repair] vs 17.0% [replacement]; P = .11). Conclusions: MV repair performed in primary or secondary MR and reduced LVEF provides superior long-term results compared with replacement. Severe LV dysfunction is a significant predictor of reduced survival following MV surgery.
