Mitral valve reconstruction is justified in patients with end stage heart failure – Long term follow up in 193 patients

Objectives: Severe mitral regurgitation (MR) is a frequent finding in end-stage cardiomyopathy. We analyzed the outcome after mitral valve (MV) surgery in this patient (pt) population.

Methods: Between 11/94 and 3/05 MV surgery was performed in 193 pts (121 m, 72 f, mean age 61 a (23–87 a), 147 non ischemic cardiomyopathy (DCM), 46 ischemic cardiomyopathy (ICM)) with MR > II+. Mean EF was 25±7%, mean LVEDD 69±11mm. Mean log Euroscore was 13% (2% –66%). Pts. underwent MV reconstruction (n=157) or MV replacement (n=36). Average Follow up was 30±28 (0–117) months.

Results: Overall 30 day mortality was 9.3% (18/193), in DCM patients 7.5% and in ICM patients 15.2% (p=0.261). In 14 pts. Htx was performed 190±669 days after MV surgery. Actuarial survival after 1 and 5 years was 77% and 56% respectively. In patients with DCM actuarial survival after 1 and 5 years was 78% and 61%, in ICM patients 72% and 30% respectively (log rank 0.047). After MV repair 1 and 5 year survival was 80% and 60%, after MV replacement 61% and 43%, respectively (log rank 0.009). Neither age, gender, LVEF, LVEDD or type of surgical approach showed significant influence.

Conclusion: Mitral valve repair can be performed with an acceptable long term mortality even in patients with advanced heart failure, modifying selection criteria for potential candidates may further improve long term outcome.