Survival Trends of Patients After Mitral Valve Repair for Structural Mitral Regurgitation Compared to the General Population

Background: Surgical mitral valve repair (MVr) for structural mitral regurgitation (MR) restores valve function. Individual studies suggest that MVr may normalize life expectancy. We performed a systematic review and a meta-analysis of all studies assessing the impact of MVr for structural MR on survival.

Methods: Three databases were assessed searching for studies with survival comparisons to the regional age-matched general population. The primary and single endpoint was long-term mortality. Individual patient data (IPD) were reconstructed from the published Kaplan-Meier curves and was used to calculate overall survival. The Cox proportional hazards regression model was used to assess between-group differences. The hazard ratios (HR) and 95% confidence intervals (CI) of each individual study was calculated. Landmark analysis was performed to check the robustness of the estimated effect.

Results: Four studies met the criteria for inclusion in the final analysis. The studies’ follow-up ranged from 10 to 26 years. The pooled Kaplan-Meier curves of reconstructed IPD show that for the entire follow-up, patients who underwent MVr had higher risk of death compared with the general age-matched population (HR: 0.62, 95% CI: 0.53–0.72, p < 0.01). Due to violation of the HR proportions, a landmark analysis was performed splitting the events after 6 years. There was no survival difference between the groups until 6 years after surgery (HR: 0.83, 95% CI, 0.68–1.03, p = 0.09). From 6 to 26 years of follow-up, curves diverged and the MVr group demonstrated significantly higher risk of death compared with the general age-matched population (HR: 0.45, 95% CI, 0.36–0.56, p < 0.01). The individual studies showed that the decrease in survival after 6 years was associated with an increase in return of MR and need of reoperation.

Conclusion: MVr for structural MR has the potential to restore life expectancy compared with the general population. However, this effect is limited to the first 6 years after surgery. Risk of death thereafter correlates with the return of severe regurgitation and/or the need for reoperation.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025