Eastern Cardiothoracic Surgical Society

Risk factors for Recurrent Regurgitation Following Mitral Valve Repair in Degenerative Disease
William K. Childers, Mubashir Mumtaz, Nathaniel Melton, John Lazar, David Loran, William Apollo,  Pinnacle Health System, Harrisburg, PA


OBJECTIVE: In degenerative mitral valve disease, numerous repair technique have been described, however, repair failure or recurrent mitral regurgitation (MR) after repair presents a unique situation that not be fully elucidated. Using multivariate analysis, further investigation of risk factors, concomitant procedures, and repair techniques will be evaluated at their propensity of influencing recurrent MR after surgical repair.

METHODS: A single institution, retrospective review of 263 patients with degenerative mitral valve disease from 2008-2014 who underwent mitral valve. Patients with follow up echocardiograms were included, and recurrence was described as moderate, moderate-severe, or severe. Pre-operative, peri-operative, post-operative complications, repair technique, 30-day mortality, overall mortality, and 30-day readmissions were all evaluated.

RESULTS: 211 (80.2%) patients did not develop recurrent MR, and 42 (19.8%) patients had developed recurrent MR. With the multivariate analysis, the 2 endpoints of age >65 (p=0.042) and the use of a complete ring annuloplasty (p=0.039) demonstrated statistical significance in reducing the developing of recurrent MR. Factors involved in increasing the potential of developing recurrent MR with statistical significance included concomitant AVR (p=0.022), TVR (p=0.028), the use of blood products (0.027), and the repair technique of a neochord (p=0.035) and chordal transfer (p=0.019).

CONCLUSIONS: The development of recurrent MR is more common in patients with concomitant AVR, TVR, the use of blood products, and the use of the repair techniques neochord and chordal transfer. However, the patient older than 65, and the use of a complete ring annuloplasty has demonstrated to be protective in the development of recurrent MR.