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Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Introduction

Mitral valve repair is the accepted treatment for mitral regurgitation (MR) but lack of resources and socioeconomic concerns delay surgical referral and intervention in developing countries. We evaluated immediate and short-term results of mitral valve repair for non-ischemic MR at our centre and aimed to identify the predictors of in-hospital and follow-up mortality.

Materials and methods

The study was conducted at a tertiary-level hospital in South India. All patients >18 years with severe non-ischemic MR who underwent mitral valve repair over a period of 6 years were included. Perioperative data was collected from hospital records and follow-up data was obtained by prospective methods.

Results

There were 244 patients (170 males). Most of the patients were in the age group 31–60 years (76.6%). Aetiology of MR was degenerative (n = 159; 65.2%), rheumatic (n = 34; 13.9%), structural (n = 42; 17.2%), or miscellaneous (n = 9; 3.7%). All patients underwent ring annuloplasty with various valve repair techniques. One hundred patients (44.7%) underwent additional cardiac procedures. At discharge, MR was moderate in 4 patients; the rest had no or mild MR. The mean hospital stay of survivors was 7.1 days (SD 2.52, range 5–25 days). There were 9 in-hospital deaths (3.68%) and 10 deaths during follow-up (4.2%). The mean follow-up period was 1.39 years, complete for 87.6%. Pre-operative left ventricle ejection fraction (LVEF) <60% (p = 0.04) was found to be significantly associated with immediate mortality. Logistic regression analysis detected age (p = 0.019), female sex (p = 0.015), and left ventricular (LV) dysfunction at discharge (p = 0.025) to be significantly associated with follow-up mortality.

Conclusion

Pre-operative LV dysfunction was identified as a significant risk factor for in-hospital mortality. Female sex, age greater than 45 years, and LV dysfunction at discharge were found to be significantly associated with follow-up mortality. Hence, it is important to perform mitral valve repair in severe regurgitation patients before significant LV dysfunction sets in for a better outcome.

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Acknowledgements

We thank Mr. Arun, Office Assistant, for the help rendered in collecting follow-up data.

Funding

None.

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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India

    Vinitha Viswambharan Nair, Joseph Thomas Kathayanat, Nidheesh Chooriyil, Ratish Radhakrishnan & Jayakumar Thanathu Krishnan Nair

  2. Government Medical College, Kottayam, India

    Syam Das & Ramesh Bhaskaran Nair

  3. Department of Cardiac Anaesthesia, Government Medical College, Kottayam, India

    Thomas Pandarakalam George

Authors
  1. Vinitha Viswambharan Nair
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  2. Syam Das
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  3. Ramesh Bhaskaran Nair
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  8. Jayakumar Thanathu Krishnan Nair
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Correspondence to Vinitha Viswambharan Nair.

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Conflict of interest

The authors declare no competing interests.

Informed consent

The study started after obtaining clearance from the Ethics committee. As this was a retrospective analysis , informed consent was obtained from the patients during follow up echocardiography.

Ethics Committee approval

No. SBMR IRC:03/2016 - Institutional Research Committee, Government Medical College, Kottayam, dated 29/01/2016.

Statement on human and animal rights

The research was conducted in accordance with the ethical standards of the institutional research committee( Kottayam Medical College) on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008(5). No laboratory animals were involved in the study and no intervention involved on humans or animals during the process of conduct of the research.

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Nair, V.V., Das, S., Nair, R.B. et al. Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors. Indian J Thorac Cardiovasc Surg 37, 506–513 (2021). https://doi.org/10.1007/s12055-021-01160-x

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  • DOI: https://doi.org/10.1007/s12055-021-01160-x

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