Outcome of Mitral Valve Surgery in Patients with Chronic Mitral Regurgitation and Low Ejection Fraction: Repair or Replacement?

Objective: The amount of patients with functional mitral valve insufficiency and congestive heart failure with low ejection fraction (EF) is increasing. Whether mitral valve repair or replacement is superior regarding long-term outcome is this special patient group not yet clear and well studied. We analyzed the outcome data of all patients with mitral valve surgery and ejection fraction below 30%. Methods: We retrospectively analyzed data of 433 patients with chronic mitral regurgitation undergoing repair or replacement of the mitral valve either with a preoperative EF below 30% ( n = 86, 19.9%) or between 30 and 50% ( n = 347, 80.1%) between 2004 and 2012. Patients with endocarditis and other additional cardiac procedures except coronary artery bypass grafting (CABG) were excluded. Results: Patients with low EF were borderline significant more male (76.7 vs 66%, p = .070) but with a similar age (67.8 ± 9.4 vs 66.7 ± 11.5 years, p=.408) compared with patients with an EF of 30 to 50%. In the low EF group 79.1% of the mitral valves could reconstructed, in the EF30–50 group 66.9% (p = .036). All patients showed significant improvement in EF and reduction in MI grade measured by echocardiography and better NYHA class. These parameters were comparable between mitral valve reconstruction and replacement. CABG as an additional procedure was performed in 66.3% with low EF and 49% with moderate EF (p = .005). The figure shows the Kaplan-Meier Survival. All groups had significant different survivals, except replacement with moderate EF versus reconstruction in low EF (p = .113). Conclusion: Patients with low ejection fraction and mitral valve insufficiency have a worse long-term survival with mitral valve replacement. Reconstructive surgery should be attempted, especially in patients with low ejection fraction. Fig. 1 Kaplan-Meier Survival with mitral valve reconstruction/replacement in different EF groups. MVR, mitral valve reconstruction; MVP, mitral valve replacement.