Outcomes of Patients Undergoing Mitral Valve Replacement after Failed Attempt at Mitral Valve Repair

Le résumé fourni par la source

Objective Mitral valve repair (MVr) is the ideal treatment strategy for degenerative mitral regurgitation. Mitral valve replacement (MVR) may be required if MVr is unsuccessful during the index operation. The consequences of MVR following failed MVr during the same surgery are unclear. Design A retrospective observational study Setting A single-institution, university-affiliated Participants All patients who underwent MVR from 2010 through 2024 were included. Patients with concomitant surgeries were included. Interventions Patients were dichotomized into intended repair (IR) or de novo replacement (DR) groups based on intended procedure. Measurements and Main Results 1661 patients (64 years old, 57% female) underwent MVR. MVr was attempted in 133 (8%, IR group) and 1528 underwent planned MVR (92%, DR group). Mean ejection fraction was 55%. Female sex (58.0% DR vs. 48.9% IR, P=0.04), history of infective endocarditis (23.8% vs. 15.0%, P=0.02), cerebrovascular disease (32.1% vs. 19.5%, P=0.03), and prior sternotomy (32.1% vs. 15.8%, P<0.001) were more prevalent in the DR group. After propensity score matching, perioperative morbidity and mortality were similar. Median cardiopulmonary bypass time and cross-clamp time were longer in the IR group (207 minutes vs. 134 minutes DR, and 163 minutes vs. 102 minutes DR, respectively). Kaplan-Meier curve showed similar five-year survival (P=0.91). Conclusions Postoperative outcomes were similar despite longer operative times in the IR group. Failure of initial MVr , leading to MVR, did not translate into adverse early or long-term outcomes. These findings suggest that repair may be more aggressively considered in repairable anatomies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.