After
a 5-year follow-up, would you repair the mitral valve or replace it?
Majd Makarious Laham1, Jerry Easo1,
Marcin Szczechowicz1, Mehdy
Roosta-Azad1, Alexander Weymann1,
Arjang Ruhparwar1, Markus Kamler1
West German Heart and Vascular
Center, University Hospital of Essen, Essen, Germany
Acknowledgments: No conflicts or competing interest
Clinical trial registration: N/A
Word count: 4504
Corresponding author: Majd Makarious Laham
West German Heart and Vascular
Center
Heart Surgery Huttrop
University Hospital Essen
Herwarth Str 100, 45138 Essen, Germany
E-mail: majdlaham@gmail.com
Tel.: +49-201 28022-584 Fax: +49-201 28022-13
Running Head:Reconstruction versus Repair
Keywords: mitral valve, repair, replacement
ABSTRACT:
Background:Mitral valve repair (MVRe) is considered to have a superior outcome
compared to replacement (MVRp) in patients with mitral valve
regurgitation (MVR). It was the aim of the study to analyze the clinical
results and identify risk factors for short and long-term mortality.
Methods: In a single-center analysis, patients undergoing
isolated mitral valve procedures from June 2010 to December 2016 were
identified. These were subsequently homogenized using 10 baseline
characteristics for propensity-score matching. Comparative analyses were
performed for early and long-term results, using the adequate
statistical tool, identifying risk factors for the investigated
endpoints.
Results: 241 patients were identified in the entire cohort.
After matching, patients were divided into 2 groups of 64 in each. The
median age was similar. There was significant interaction to early
mortality risk of MV in patients with coronary artery disease (CAD) (OR
11.94, 95% CI: 1.49-285.92, P=0.04) and late mortality in patients with
higher EuroSCORE II (HR 1.14, 95% CI: 1.06-1.23, P<0.001).
5-year survival was significantly higher in MVRe versus MVRp (90.06%
vs. 79.54% respectively, P=0.04).
Conclusions: We concluded MVRe to be associated with lower
operative and 5-year mortality and good postoperative outcomes compared
to patients undergoing MVRp. Concomitant CAD was identified as one of
the risk factors for increasing the in-hospital mortality rate. There
was no significant difference in rehospitalization over the follow-up
period. MVRe should be the treatment of choice for severe MVR and should
remain a central aspect in valve centers’ treatment algorithms and
quality measures.