MP62. Surgery Management of Asymptomatic Patients with Severe Mitral Regurgitation. Clinical Practice Based on Guidelines.
Presented During: Moderated E-Posters
Hcor-SP
São Paulo, NA
Brazil - Contact Me
Cardiovascular Surgery Resident - HCor, Brazil
MSc Student - The University of Edinburgh, UK
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Mitral repair is considered the gold standard for mitral regurgitation and is recommended by the main guidelines in the management of diseases of the mitral valve apparatus, even in asymptomatic patients.
The aim of this study is to evaluate the risk-benefit ratio of mitral valve repair in patients with severe mitral regurgitation without symptoms or with mild symptoms.
Methods: From June 2010 to January 2021, 266 patients underwent surgery to correct isolated primary mitral regurgitation. Out of the total, 51 patients were in New York Heart Association class I, grade 3-4 isolated mitral regurgitation and comprised our study population.
Results: The mean age was 56.53± 14.44 years. The main causes of mitral insufficiency were degenerative in 48 (94.12%), Barlow in 2 patients (3.92%) and a rheumatic disease (1.96%). Leaflet prolapse was the mechanism responsible for regurgitation in 93% of cases (47/51) and of these, 23 (48%) patients had some chordal rupture. Mitral valve repair was performed in 50 patients and one patient required valve replacement due to repair failure. Mean follow-up was 58.45 ± 36.18 months. There were no deaths in this series of patients. One patient was reoperated 90 months after the first surgery (new repare). We have not presented mortality so far. One patient required permanent pacemaker implantation. The left atrial diameter decreases from 47.2+-5.08mm to 43.46+-6.6mm (p<0.001). The left ventricular end-systolic and end-diastolic diameters decreased from 40.0 ± 6.8 mm and 64.8 ± 7.0 mm to 34.6 ± 6.7 mm (p <0.001) and 52.7 ± 7, 4 mm (p<0.001).
Conclusion: Mitral valve repair for severe mitral regurgitation in patients with mild or no symptoms was performed with low mortality and morbidity, good valve function and preserved left ventricular performance. Early repair may be advocated based on the severity of regurgitation and on the possibility of the valve repair, regardless of symptoms.
The aim of this study is to evaluate the risk-benefit ratio of mitral valve repair in patients with severe mitral regurgitation without symptoms or with mild symptoms.
Methods: From June 2010 to January 2021, 266 patients underwent surgery to correct isolated primary mitral regurgitation. Out of the total, 51 patients were in New York Heart Association class I, grade 3-4 isolated mitral regurgitation and comprised our study population.
Results: The mean age was 56.53± 14.44 years. The main causes of mitral insufficiency were degenerative in 48 (94.12%), Barlow in 2 patients (3.92%) and a rheumatic disease (1.96%). Leaflet prolapse was the mechanism responsible for regurgitation in 93% of cases (47/51) and of these, 23 (48%) patients had some chordal rupture. Mitral valve repair was performed in 50 patients and one patient required valve replacement due to repair failure. Mean follow-up was 58.45 ± 36.18 months. There were no deaths in this series of patients. One patient was reoperated 90 months after the first surgery (new repare). We have not presented mortality so far. One patient required permanent pacemaker implantation. The left atrial diameter decreases from 47.2+-5.08mm to 43.46+-6.6mm (p<0.001). The left ventricular end-systolic and end-diastolic diameters decreased from 40.0 ± 6.8 mm and 64.8 ± 7.0 mm to 34.6 ± 6.7 mm (p <0.001) and 52.7 ± 7, 4 mm (p<0.001).
Conclusion: Mitral valve repair for severe mitral regurgitation in patients with mild or no symptoms was performed with low mortality and morbidity, good valve function and preserved left ventricular performance. Early repair may be advocated based on the severity of regurgitation and on the possibility of the valve repair, regardless of symptoms.