Early and long-term outcomes of mitral valve repair in degenerative mitral regurgitation

Objective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation. Methods From January 2003 to December 2015, clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively. There were 1 312 males(68.9%) and 591 females(31.1% )the mean age was(54.2±13.1)years. Early and long-term outcomes were summarized and risk factors for adverse events were assessed. Results There were 35 in-hospital deaths(1.8%) and in-hospital mortality for isolated mitral valve repair was 0.9%(10/1 163). Perioperative complications included central nerve system complications(0.7%), respiratory failure requiring tracheotomy(1.8%), acute renal injury requiring hemodialysis(1.2%) and reoperation for bleeding(0.7%). NYHA function class Ⅲ-Ⅳ(OR=3.65), atrial fibrillation(OR=2.85) and ejection fraction 60 years(HR=7.43), preoperative stroke(HR=6.51), ejection fraction 40 mm(HR=3.98) and pulmonary systolic pressure>50 mmHg(1 mmHg=0.133 kPa)(HR=2.85) were independent predictive factors for late death. Ejection fraction 60 mm(HR=1.88), leaflet lesion involving anterior leaflet(HR=2.40) and residue mild regurgitation(HR=4.17) were independent predictors for late recurrent regurgitation. Leaflet lesion involving anterior leaflet(HR=2.40) and residue mild regurgitation(HR=3.35) were independent predictor for late reoperation for mitral valve. Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation. Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes. Early surgical intervention should be restricted in experienced high-volume centers. Key words: Mitral valve repair; Mitral regurgitation; Risk factors