173 Surgery of chronic functional mitral regurgitation : post operative outcomes and respective results of undersizing annuloplasty and valve replacement

Background Dismal prognostic impact of functional mitral regurgitation (MR) in dilated cardiomyopathy has been well established. However, indication of surgery and its modalities (undersizing annuloplastie (UA) vs mitral valve replacement (MVR)) are controversial. Objectives 1/Immediate and late post-operative outcomes in patients operated for severe functional MR 2/Analysis of respective result of UA and MVR. Methods Inclusion criteria : 1/Symptomatic severe functional MR 2/Ischemic or non ischemic cardiomyopathy with LVEF Primary endpoints: 1/In-hospital mortality 2/Late mortality. Secondary endpoints: 1/evolution of LVEF 2/recurrence of MR. Results 33 patients(age = 65±10, LVEF = 36 ± 6%, ERO= 41 ± 17 mm 2 ). Surgery : 11 UA and 22 MVR. No per-operative death. In-hospital mortality: 6% in total population, 9% in UA group, 4.5% in MVR group (p = NS). Late postoperative mortality: 3 years survival: 77% in total population, 88% in UA group and 71% in MVR group (p> 0.99). By multivariable analysis, only age (1.3 [1,1-1,5], p = 0001) and LV end systolic diameter(1.16 [1, 05-1.29], p=0005) independently predicted late mortality whereas type of surgery did not(0.6 [0,1-3,9], p = 0.6). Evolution of the LVEF: LVEF did not change after surgery in the MVR group (36 ± 6% vs 36 ± 7%, p = 0.1) but tended to decrease in the UA group (36 ± 6% vs 30 ± 12%, p = 0.06) MR recurrence: No recurrence in the MVR group whereas 80% recurrence in the UA group (ERO= 21±6 mm 2 ). Conclusions functional MR surgery can be performed with relatively low operative risk, including in most severe patients, and acceptable mid-term result. MVR is a reasonable option with similar early results than UA but without exposing patient to MR recurrence risk particularly high in our series.