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Contemporary Outcomes of Mitral Valve Repair for Degenerative Disease in the Era of Increased Penetrance of Percutaneous Mitral Valve Technology

Open AccessPublished:November 15, 2022DOI:https://doi.org/10.1016/j.xjon.2022.11.004
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      STRUCTURED ABSTRACT

      Objective

      To evaluate surgical outcomes of MV repair in the era of percutaneous technology.

      Methods

      We retrospectively reviewed 452 patients who underwent MV repair for degenerative disease between 2010 and 2021. Survival, MV reoperation, and mitral regurgitation (MR) recurrence were assessed using Cox-regression, dichotomized for those younger and older than 60 years of age.

      Results

      Median age in years (IQR) was 52 (47-57) in the younger cohort and 67 (63-73) in the older cohort (p<0.0001). Preoperative comorbidities and leaflet pathology were comparable between groups. After adjustment for sex, prior sternotomy, diabetes, atrial fibrillation, and type of leaflet repair, age ≥60 was not associated with increased mortality (HR 6.96, 95% CI 0.85-56.8, p=0.07). Considering death as a competing outcome, cumulative incidence of MV reoperation at 1, 3, and 5 years was 0.9, 1.4, 1.8% in the younger cohort, and 2.7, 4.0, 5.1% in older cohort (SHR 2.95, 95% CI 0.84-10.4, p=0.09). Cumulative incidence of MR recurrence with moderate-severe or greater MR at 1, 3, and 5 years was 1.4, 3.6, and 5.1%, and 2.7, 3.5, and 4.7% in the younger and older cohorts, respectively (SHR 0.85, 95% CI 0.29-2.50, p=0.76). Subgroup analysis focusing on isolated MV repairs (n=388) showed equivalent results with respect to mortality (HR 5.31, 95% CI 0.64-44.0, p=0.12), MV reoperation (SHR 4.04, 95% CI 0.89-18.4, p=0.07), and MR recurrence (SHR 0.98, 95% CI 0.30-3.15, p=0.97).

      Conclusions

      MV repair outcomes continue to be excellent, even in low-risk patients over the age of 60.

      Graphical abstract

      Keywords

      GLOSSARY OF ABBREVIATIONS:

      MV (Mitral Valve), MVr (Mitral Valve Repair), MR (Mitral Regurgitation), DMVD (Degenerative Mitral Valve Disease), CMS (Centers for Medicare and Medicaid Services), STS (Society of Thoracic Surgeons), AHA (American Heart Association), ACC (American College of Cardiology), IQR (Interquartile Range), HR (Hazard Ratio), SHR (Sub-Hazard Ratio), OR (Odds Ratio), CI (Confidence Interval), SD (Standard Deviation), TTE (Transthoracic Echocardiogram), TEE (Transesophageal Echocardiogram), LVEF (Left Ventricular Ejection Fraction), TEER (Transcatheter Edge-to-Edge Repair), TMVR (Transcatheter Mitral Valve Repair)