157: Surgery of chronic functional mitral regurgitation: Interest of mitral valve replacement in severe heart failure patients

BackgroundModalities (undersizing annuloplasty – UA- vs mitral valve replacement – MVR-) and outcome of surgical treatment of functional mitral regurgitation (FMR) are still debated.ObjectivesEarly and mid-term outcome of patients operated for symptomatic severe FMR; Comparison of respective results of UA and MVR.Methods Inclusion criteria: Severe FMR due to either ischemic or non ischemic cardiac disease; Heart failure symptoms despite optimal medical treatment; LVEF<40%.Primary endpoints: In-hospital mortality; Late CV mortality Secondary endpoints: Evolution of LVEF after surgery; Recurrence of MR.Results59 consecutive patients included between 1997 and 2011, mean age=65±10, i schemic disease in 41 (70%), heart failure symptoms in all, LVEF= 36±6%, ERO=41±17mm2.Surgical procedures included 12UA and 47 MVR with only 8 (13%)concomitant CABG. MVR and UA groups were comparable for age, ischemic etiology, LVEF, ERO and sPAP (all p>0.5).Inhospital mortality: 3.3% overall, 8.3% in UA group and 2.1% in MVR group (p=0,36).Eight-year survival free from CV death: 58±13% in the total population, 60±18% in the UA group and 72±10% in the MVR group (p=0.48). By multivariable analysis, older age (1.22 [1,05-1,42], p=0,008) and LV end-diastolic diameter (1.25 [1.05–1.49], p=0,01) independently predicted late mortality with borderline effect of pre-op LVEF (1.1[0.99–1.2], p=0,08) whereas type of surgery did not (1.7 [0,38–7.55], p=0.48). LVEF did not change between pre-op and late FU echo in the MVR group (36±6% vs 36±10%, p=0.68) but tended to decrease in the UA group (37±5.8% vs 31±12%, p=0.1). In the UA group, 50% of patients experienced recurrence of significant MR (mean post-op ERO=19±4mm2) whereas no patients in the MVR group presented with post-op MR.ConclusionsDespite severe clinical and echocardiographic presentation, surgical treatment of FMR can be performed with an acceptable operative risk and mid-term survival. MVR is a reasonable approach, which does not expose patients to MR recurrence, particularly frequent after UA