Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission
Open Access
- 1 January 2022
- journal article
- research article
- Published by Scientific Research Publishing, Inc. in World Journal of Cardiovascular Surgery
- Vol. 12 (06), 135-152
- https://doi.org/10.4236/wjcs.2022.126011
Abstract
Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75; MVR: n = 23) and 1 year (MVr: n = 75; MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.Keywords
This publication has 24 references indexed in Scilit:
- Percutaneous Mitral Valve Repair: Lessons From the EVEREST II (Endovascular Valve Edge-to-Edge REpair Study) and BeyondJACC: Cardiovascular Interventions, 2011
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- What are the costs of heart failure?EP Europace, 2011
- Functional Mitral RegurgitationCardiology in Review, 2010
- Long-term prognostic value of mitral regurgitation in acute coronary syndromesHeart, 2010
- Recurrent Mitral Regurgitation and Risk Factors for Early and Late Mortality After Mitral Valve Repair for Functional Ischemic Mitral RegurgitationThe Annals of Thoracic Surgery, 2008
- Restrictive Mitral Annuloplasty Cures Ischemic Mitral Regurgitation and Heart FailureThe Annals of Thoracic Surgery, 2008
- Prognostic significance of echocardiographically defined mitral regurgitation early after acute myocardial infarctionAmerican Heart Journal, 2005
- Mechanism of Recurrent Ischemic Mitral Regurgitation After AnnuloplastyJournal of the American College of Cardiology, 2004
- Intermediate-Term Outcome Of Mitral Reconstruction In CardiomyopathyThe Journal of Thoracic and Cardiovascular Surgery, 1998