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.