The Effect Of Surgical Risk On Early And Long-term Outcomes After Mitral Valve Repair For Degenerative Regurgitation
Ali Hage, Fadi Hage, Philip Jones, Usha Manian, Nikolaos Tzemos, Michael W.A. Chu.
Western University, London, ON, Canada.
BACKGROUND: In patients presenting for surgical repair of severe degenerative mitral regurgitation (MR), it is believed that those requiring redo surgery, urgent surgery, concomitant surgery or operation in the setting of endocarditis, have a higher surgical risk and potentially worse outcomes.
METHODS: We set out to compare the long-term clinical and echocardiographic outcomes of mitral repair for lower-risk versus higher-risk patients. Seventy-four higher-risk patients underwent repair for severe degenerative MR and were compared to 203 lower-risk patients. Patients were prospectively followed for a maximal duration of 9 years. At baseline, higher-risk patients were older (67.3±11.5 years vs. 61.3±13.8 years, P<0.0001), more diabetics (13.5%, n=10 vs. 3.9%, n=8, P=0.004), with more coronary artery disease (33.8%, n=25 vs. 4.9%, n=10, P<0.0001), cerebral vascular disease (12.2%, n=9 vs. 3.4%, n=7, P=0.006), and congestive heart failure (36.5%, n=27 vs. 11.3%, n=23, P<0.0001).
RESULTS: Post-operatively, the higher-risk group had more respiratory failure (5.4%, n=4 vs. 0.5%, n=1, P=0.007), renal failure (6.8%, n=5 vs. 0%, n=0, P<0.0001), and use of intra-aortic balloon pump (2.7%, n=2 vs. 0%, n=0, P=0.2). They had longer ICU (3.5±8.2 days vs. 1.3±1.1 days, P=0.03) and hospital LOS (10.3±12.8 days vs. 6.2±2.7 days, P=0.008). Both groups had similar rates of myocardial infarction (total n=1, P=0.5) and stroke (total n=5, P=0.09). There was no difference in in-hospital death (total n=1, P=0.5), in-hospital re-intervention (total n=2, P=0.4), or re-operation for bleeding (total n=4, P=0.2). Early in-hospital residual MR was similar between both groups (MR grade ≤1: 100% for both groups, P=1.0). At 9 years, late survival (86.1% for all patients, P=0.3), and actuarial freedom from re-operation or valve-related complications (80.1% for all patients, P=0.2), NYHA>2 (82.8% for all patients, P=0.3) or MR>2 (98.4.7% for all patients, P=0.3) were similar for all patients.
CONCLUSIONS: Despite having higher rates of some early post-operative complications, higher-risk patients presenting for MV repair with experienced mitral repair teams have similar survival and freedom from complications at long-term follow-up, as compared to lower-risk patients.
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