TITLE:
Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission
AUTHORS:
Joseph A. Gancayco, Alexander P. Kossar, Codruta Chiuzan, Isaac George
KEYWORDS:
Mitral Regurgitation, Mitral Valve Repair, Mitral Valve Replacement, Heart Failure
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.6,
June
30,
2022
ABSTRACT: Background: Functional mitral
regurgitation (FMR) is a significant burden among our increasingly elderly
population. 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.