Introduction
Since the emergence of percutaneous transcatheter mitral valve edge-to-edge repair, there have been more and more concerns about and understanding of mitral valve regurgitation.1,2According to the guideline for valve disease, there is consensus for surgical correction of the valve with primary mitral valve regurgitation because mechanical valve dysfunction can be fixed only by a mechanical solution.3,4 On the other hand, secondary mitral regurgitation is referred to as left ventricular disease, not valve leaflet disease. Regurgitation itself is regarded as only one component in this situation, and restoration of mitral valve competence is not curative.4,5 However, the presence of even moderate mitral regurgitation is associated with a worsened prognosis in ischemic mitral valve regurgitation, which is a form of secondary mitral valve regurgitation.6,7 Correction of secondary mitral regurgitation seems to be beneficial.
The Mitra Clip (Abbott Vascular, Menlo Park, CA) has been proven to improve survival and hospitalization for a certain subset of secondary mitral valve regurgitation patients.2,8 The Mitra Clip is less invasive than cardiac surgery, but it does not seem to offer superior control of mitral regurgitation compared to the surgery.9 Mitral valve surgery can provide greater benefits in the postoperative course over the long-term if accomplished without increasing perioperative mortality or morbidity.
Clarification of early and long-term results of surgical correction for secondary mitral valve regurgitation is very important, especially in patients with poor left ventricular function, because high surgical mortality and morbidity rates are anticipated in this situation.
The purpose of this study was to retrospectively investigate the operative and long-term results of mitral valve surgery for secondary mitral regurgitation with poor left ventricular function defined as left ventricular ejection fraction (LVEF) ≤30%. As a sub-analysis, risk factors for long-term mortality were also investigated.