Results of mitral valve surgery for secondary regurgitation with poor
left ventricular function
Abstract
Background and aim: Surgical repair of secondary mitral regurgitation is
still controversial especially when the cardiac function is reduced. The
purpose of this study was to retrospectively investigate the operative
and long-term results of mitral valve surgery for secondary mitral valve
regurgitation with poor cardiac function. Risk factors for long-term
mortality were also investigated. Methods Patients with preoperative
echocardiographic left ventricular ejection fraction ≤30% who underwent
mitral valve surgery due to secondary mitral regurgitation comprised the
study group. Cardiac function and valve regurgitation was assessed with
echocardiogram using modifiled Simpson’s method and color-flow Doppler.
Peri-operative results and long-term survival were investigated. Results
Sixty-nine patients (mean age 65.5 years, 58 males) with secondary
mitral regurgitation and poor left ventricular function comprised the
study group, and their early results were investigated; long-term
results were evaluated in 66 cases. There were no operative/in-hospital
deaths. Postoperative echocardiograms showed significantly improved
mitral regurgitation, from moderate to severe to less than trivial
(p<0.001), although poor left ventricular function remained.
Actual 1-, 3-, and 5-year survival rates were 90.5%, 76.5%, and
63.4%, respectively. The 1-, 3-, and 5-year re-admission-free rates due
to heart failure were 74.6%, 61.6%, and 55.3%, respectively. Patients
with clinical frailty scale scores ≥4 had a worse prognosis than
patients with clinical frailty scale scores <4 (log-rank
p=0.046). Conclusions Open mitral valve surgery could be appropriate for
secondary mitral valve regurgitation with poor cardiac function,
however, operative indications should be considered carefully in
patients with high clinical frailty scale scores.