| Institution: | 1. Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill;2. Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Ill;1. University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany;2. Peter Munk Cardiac Center, Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada;1. Department of Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania;2. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan;3. Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York;1. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;2. Netherlands Heart Registry, Utrecht, The Netherlands;3. Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;4. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;5. Department of Cardiothoracic Surgery, Isala, Zwolle, The Netherlands;6. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;7. Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;8. Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands;1. Division of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch–Galveston, Galveston, Tex;2. Division of Cardiology, University of Texas Medical Branch–Galveston, Galveston, Tex;1. Cardiac Surgery Center, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China;2. Beijing Institute of Heart Lung and Vascular Disease, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China |
| Abstract: | ObjectivesDuring degenerative mitral repair, surgeons must decide if further repair is warranted for residual mild mitral regurgitation. We examined the incidence of mild mitral regurgitation, late echocardiographic and clinical outcomes, and influence of surgical experience in decision making.MethodsFrom April 2004 to June 2018, 1155 of 1195 patients with pure degenerative disease underwent repair (97% repair rate). Propensity score matching was performed between patients with trace/no mitral regurgitation and patients with mild residual mitral regurgitation. Late echocardiographic outcome and freedom from reoperation were compared using competing-risks models. A comparison of outcomes of the referent surgeon (89.8% of repairs) with all other surgeons was performed.ResultsMild mitral regurgitation was present in 73 patients (6%). Propensity score–matched analyses compared 69 patients with mild mitral regurgitation with 198 patients without mitral regurgitation. Late moderate or greater mitral regurgitation was higher in those with mild mitral regurgitation than in those with no mitral regurgitation (17% vs 7%, P = .033), as was late moderate-severe or greater mitral regurgitation (6% vs 1%, P = .016). Ten-year freedom from reoperation was low in both groups (99.5% no vs 96.9% mild; P = .10). The referent surgeon had fewer patients with mild residual mitral regurgitation (6% vs 11%, P = .027) and less progression of mitral regurgitation compared with other surgeons (late moderate or greater mitral regurgitation 6% vs 15%, P = .002).ConclusionsResidual mild mitral regurgitation was uncommon, and late progression to moderate or greater mitral regurgitation was rare and never led to late mitral reoperation. Experienced surgeons may be better able to determine repairs likely to remain stable, and most mild residual mitral regurgitation does not require re-repair. |
