Long-term outcome after mitral valve repair: a risk factor analysis

Objective: Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome. Methods: We retrospectively studied our first 175 consecutive adult patients (mean age: 64 +/- 10.4 years; 113 mates) who underwent primary mitral valve repair associated with any other cardiac procedures between January 1986 and December 1998. Risk factors influencing reoperations and late survival were plotted in a uni- and muttivariate analyses. Results: Operative mortality was 3.4% (6 deaths, 0-22nd postoperative day (POD)). Late mortality was 9.1% (16 deaths, 3rd-125th POM). Reoperation was required in five patients. Kaplan-Meier actuarial analysis demonstrated a 96 +/- 1% 1-year survival, 88 +/- 3% 5-year survival and a 69 +/- 8% 10-year survival. Freedom from reoperations was 99% at 1 year after repair, 97 +/- 2% after 5 years and 88 +/- 6% after 10 years. Multivariate analysis demonstrated that residual NYHA class III and IV (p = 0.001, RR 4.55, 95% CI: 1.85-14.29), poor preoperative ejection fraction (p = 0.013, RR 1.09, 95% CI: 1.02-1.18), functional MR (p = 0.018, RR 4.17, 95% CI: 1.32-16.67), and ischemic MR (p = 0.049, RR 3.13, 95% CI: 1.01-10.0) were all independent predictors of late death. Persistent mitral regurgitation at seventh POD (p = 0.005, RR 4.55, 95% CI: 1.56-20.0), age below 60 (p = 0.012, RR 8.7, 95% CI: 2.44-37.8), and absence of prosthetic ring (p = 0.034, RR 4.76, 95% CI: 1.79-33.3) were all independent risk factors for reoperation. Conclusions: Mitral valve repair provides excellent survival. However, longterm outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral. regurgitation and without ring annuloplasty. (C) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.