Surgery For Functional Mitral Regurgitation: Results From A Contemporary Series
Beatrice Bacchi, Alfredo Giuseppe Cerillo, Gabriele Giunti, Enrico Carone, Pierluigi Stefano.
Careggi University Hospital, Florence, Italy.
Background: The presence of functional mitral regurgitation (MR) negatively affects the prognosis of patients with left ventricular (LV) dysfunction. Recently, the COAPT trial has demonstrated that transcatheter correction of functional MR may improve the survival and reduce the hospitalisation of patients with impaired LV function. Mitral surgery is a milestone in the surgical therapy of heart failure patients, and has been shown to be superior to catheter-based therapy in reducing the recurrence rate of MR. However, several previous studies failed to show a positive effect of surgery on the survival of heart failure patients. This study aims to present the results of surgical correction of functional MR in a contemporary population.Methods: From January to December 2018, 351 patients underwent surgery for MR at the Department of Cardiac Surgery, Careggi University Hospital, Florence. Patients with severe MR and LV dysfunction (left ventricular ejection fraction (LVEF) <50%) were included. Patients with endocarditis and redo mitral procedures excluded.Results: 86/351 patients (mean age 70.6±10.47 years, 62 males) had LVEF < 50% and were included. The mean effective regurgitant orifice area (EROA) was 0.35±14.99 cm2. Mean STS and Euroscore II were 4.03/26.60 and 9,32, respectively. 18 patients had a LVEF <30% and in 68 patients we described a LVEF between 30-50%. 67 patients underwent undersized (Bolling) mitral annuloplasty, while mitral valve replacement was performed in 19 patients. Mitral replacement was always performed preserving both mitral leaflets. The in-hospital mortality was 8.1% (7 patients). Of note, all patients with "Disproportionately severe MR" (EROA > 0.3 cm2 and LVEDV < 200 ml) survived the operation. 3 additional patients died during the first year after the operation (1 year mortality: 11.6%). In 17,5% of patients, the control echocardiography showed a significant improvement of the LV function. Discussion: Our single-institution, retrospective study suggests that the results of up-to-date mitral surgery could be at least as good as those of catheter-based therapy. We therefore believe that mitral valve surgery should be considered in selected patients with severe MR and LV dysfunction. Further studies are needed to evaluate the usefulness and drawbacks of all the available therapeutic strategies in this complex population.
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