Background
Severe degenerative mitral regurgitation (MR) is a progressive disease that impairs long-term prognosis. Mitral valve repair (MVR) is the only effective treatment improving symptoms and restoring normal life expectancy. The optimal timing for surgery remains controversial in the therapeutic management of patients. Our study aimed to assess the impact of international guideline criteria for surgery, including symptoms (NYHA class), atrial fibrillation (AF), left ventricular ejection fraction (LVEF), left atrial dilatation (LA dilatation), and pulmonary arterial hypertension (PAH), on postoperative survival of patients who underwent MVR.
Methods
Based on the prospective registry of valvular diseases at the Cliniques universitaires Saint-Luc, a cohort of 578 patients (mean age 64±12 years) with MR on transthoracic echocardiography underwent MVR between January 1990 and December 2010. They were prospectively followed up by phone.
Results
Mean follow-up duration was 7.2±4.2 years. Overall survival was significantly reduced as compared to the age- and sex-matched Belgian population (73% vs. 84% at 10 years, p<0.001). Cox multivariate analysis showed that age (p<0.001), NYHA III-IV-symptoms (p=0.001), AF (p=0.043), as well as LA dilation (p=0.001) correlated with postoperative prognosis. LVEF and PAH were also significant in univariate analysis, yet not multivariate analysis. Moreover, the survival of patients who underwent MVR before the occurrence of guideline criteria was similar to that of the Belgian population.
Conclusion
We demonstrated that MVR conducted in patients meeting the international guideline criteria was associated with reduced life expectancy. On the other hand, life expectancy was restored in asymptomatic patients who underwent MVR while displaying none of these criteria. Thus, our results suggest that MVR should be considered early in the disease course, prior to the MR.
Affiliations
- Cliniques universitaires Saint- Luc UCL, Service de Cardiologie, Département des pathologies cardiovasculaires, Avenue Hippocrate 10 / 2806, B-1200, Woluwe Saint-Lambert, Belgique
- Université catholique de Louvain, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Bruxelles, Belgique