Clinical and Echocardiographic Study of Mitral Valve Repair in A Tertiary Center in Oman

Abstract

Introduction: In recent years, mitral valve (MV) repair has become the procedure of choice for treating isolated mitral regurgitation (MR). The aim of this study was to evaluate immediate and long-term clinical and echocardiographic results of MV repair performed at a tertiary hospital in Oman.Materials and Methods: The study population consisted of patients with severe MR above 18years of age who had isolated MV repair between 2006 and 2016 at Royal Hospital, Oman. Retrospective observational study. Primary Endpoints: 1-year freedom from reoperation, recurrence of severe MR and mortality. Secondary Endpoints: Five-year echocardiographic recurrence of severe MR, ejection fraction (EF), NYHA class and mortality.Results: The case records of 351 patients with MR who had MV surgery in Royal Hospital were reviewed. A total of 89 patients had isolated MV repair surgery with follow up 1 year. The etiology of mitral disease was degenerative in 58.42%, rheumatic in 20.22%, post endocarditis in 12.35%, congenital 5.61% and ischemic MR in 3.37%. Operative mortality was 2.24% (2/89). Pre-operative NHYA class III/IV was noted in 62.92% of patients (56/89). All the patients had an EF of > 60%. Among the 87 patients followed up for one-year, 95.40 % (83/87) of patients were free from reoperation. Four patients (4.59%) had recurrence of severe MR needing MV replacement surgery. Of the 87 patients, 56 patients were followed in our institute for 5 years had demonstrated trivial to mild MR in 73.2% (41/56) moderate MR in 16.07% (9/56), and severe MR in 10.07% (6/56) of patients though 83.92% (47/56) patients were in NYHA class I. Majority of grade 3 (10.71%) and 4 MR (8.92%) occurred in patients with rheumatic etiology who underwent MV repair. Ejection fraction remained > 60% in 89.28% patients. There was no mortality at 5 years among the 56 patients followed-up.Conclusions: MV repair in a tertiary center in Oman showed favorable early and one-year results as regards mortality, freedom from reoperation and recurrence of significant MR. Those followed-up at five years, majority of patients were asymptomatic though echocardiographic recurrence of moderate and severe MR was high predominantly in patients with rheumatic etiology.

Keywords

• mitral valve repair
• mitral regurgitation
• nyha class
• reoperation