Late Durability of Mitral Repair for Ischemic Versus Nonischemic Functional Mitral Regurgitation

Abstract

Background: Concerns regarding long-term durability of surgical repair for functional mitral regurgitation are based on short-term data, with few comparisons of ischemic mitral regurgitation (IMR) versus nonischemic functional mitral regurgitation (NIFMR) etiology.

Methods: Consecutive patients (N = 788) receiving mitral repair for functional mitral regurgitation were evaluated from a prospectively maintained database. Patients with other surgical procedures were included. Propensity score matching was used to compare outcomes in IMR versus NIFMR.

Results: Unmatched IMR patients tended to be older men with greater comorbidities. One hundred ninety-eight matched pairs of IMR versus NIFMR patients had similar demographics with a relatively preserved ejection fraction of 40% ± 13% and an end-systolic diameter of 4.3 ± 1.1 cm. Concomitant coronary revascularization occurred in 70% of matched IMR patients. All patients received an annuloplasty ring, usually 24 to 26 mm. Heart failure class improved from 2.8 preoperatively to 1.5 at 5 years (P < .0001). Survival at 15 years was worse with IMR (12% ± 3% vs 43% ± 5%, P < .0001). At 10 years the cumulative incidence of moderate or more (≥2+) mitral regurgitation (27% ± 4% vs 26% ± 4%, P = .4), severe regurgitation (10% ± 3% vs 8% ± 2%, P = .5), and mitral reoperation (3% ± 1% vs 3% ± 1%, P = .4) was not different between IMR versus NIFMR. Recurrent moderate regurgitation was associated with heart failure readmission but not with mortality.

Conclusions: In propensity-matched patients IMR versus NIFMR had worse survival but similar repair durability, with moderate regurgitation in 27% at 10 years and rare severe regurgitation or mitral reoperation. In selected patients with relatively preserved function, mitral repair for IMR or NIFMR can improve symptoms with durable mild regurgitation in most patients out to 10 years.