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J Thorac Cardiovasc Surg 2003;125:1143-1152
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients

From the Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.

Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.

Received for publication May 6, 2002. Revisions requested July 10, 2002; revisions received July 15, 2002. Accepted for publication Aug 30, 2002. Address for reprints: T. E. David, MD, 200 Elizabeth St, 13EN-219, Toronto, Ontario, Canada M5G 2C4 (E-mail: tirone.david{at}uhn.on.ca).

Objectives: We sought to evaluate the long-term results of mitral valve repair in patients with mitral regurgitation caused by floppy mitral valves and compare the outcomes of asymptomatic patients with those of symptomatic patients.
Methods: A retrospective review of 488 consecutive patients who had mitral valve repair for floppy mitral valve disclosed 199 patients who were asymptomatic or had minimal symptoms and 289 patients who were symptomatic at the time of the operation. Asymptomatic patients were younger, had better ventricular function, had a lower incidence of coronary artery disease, and had higher rates of atrial fibrillation than symptomatic patients.
Results: Survival at 15 years was 61% for all patients. Survival was 76% for asymptomatic patients, which was identical to that for the general population matched for age and sex, whereas the survival of symptomatic patients was 53% and significantly lower than that of the general population. Cox regression analyses validated by means of bootstrap methodology identified the following predictors of late death: age by increments of 5 years (risk ratio = 1.2), New York Heart Association functional classes 3 and 4 (risk ratio = 3.0), left ventricular ejection fraction of less than 40% (risk ratio = 2.7), preoperative stroke or transient ischemic attack (risk ratio = 3.1), previous cardiac operation (risk ratio = 4.6), and severe chronic obstructive pulmonary disease (risk ratio = 3.1). Freedom from reoperation at 15 years was 91%, and it was similar for asymptomatic and symptomatic patients. Freedom from mitral regurgitation of greater than 2+ at 15 years was 85% for all patients, 96% for asymptomatic patients, and 76% for symptomatic patients.
Conclusions: This study supports the recommendation of surgical intervention in asymptomatic patients with mitral regurgitation caused by a floppy mitral valve if mitral valve repair is feasible and associated with low operative mortality and morbidity.