Mid- and long-term efficacy of mitral valve plasty versus replacement in the treatment of functional mitral regurgitation: A 10-year single-center outcome_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Hanqing ^1,2 , WAN Qiaoli ³ , WEI Tao ³ , LI Rui ³ , GUO Zhipeng ³ , ZHANG Jian ³ , YIN Zongtao ³ ,  HAN Jinsong ³

1. General Hospital of Northern Theater Command, The Graduate Training Base of Jinzhou Medical University, Shenyang, 110016,P. R. China;
2. Department of Cardiovascular Surgery, Xuzhou First People's Hospital, Xuzhou, 221000, Jiangsu, P. R. China;
3. Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Mitral regurgitation; functional mitral regurgitation; mitral valve plasty; mitral valve replacement

DOI：

10.7507/1007-4848.202302035

Video：

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Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

Citation： LIANG Hanqing, WAN Qiaoli, WEI Tao, LI Rui, GUO Zhipeng, ZHANG Jian, YIN Zongtao, HAN Jinsong. Mid- and long-term efficacy of mitral valve plasty versus replacement in the treatment of functional mitral regurgitation: A 10-year single-center outcome. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(1): 108-113. doi: 10.7507/1007-4848.202302035 Copy

1.	Izumi C, Eishi K, Ashihara K, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J, 2020, 84(11): 2037-2119.
2.	Abe Y, Takahashi Y, Shibata T. A new disease entity: Atrial functional mitral regurgitation. J Cardiol, 2021, 77(6): 565-569.
3.	Vajapey R, Kwon D. Guide to functional mitral regurgitation: A contemporary review. Cardiovasc Diagn Ther, 2021, 11(3): 781-792.
4.	Ailawadi G, Lim DS, Mack MJ, et al. One-year outcomes after MitraClip for functional mitral regurgitation. Circulation, 2019, 139(1): 37-47.
5.	叶蕴青, 吴永健. 功能性二尖瓣反流的治疗进展. 中国心血管杂志, 2015, 20(6): 480-482.Ye YQ, Wu YJ. Progress in the treatment of functional mitral regurgitation. Chin J Cardiovasc Sci, 2019, 139(1): 37-47.
6.	Wagner CM, Brescia AA, Watt TMF, et al. Surgical strategy and outcomes for atrial functional mitral regurgitation: All functional mitral regurgitation is not the same! J Thorac Cardiovasc Surg, 2022, 167(2): 647-655.
7.	Watanabe N, Maltais S, Nishino S, et al. Functional mitral regurgitation: Imaging insights, clinical outcomes and surgical principles. Prog Cardiovasc Dis, 2017, 60(3): 351-360.
8.	潘文志, 周达新, 葛均波. 二尖瓣反流机制的新认识及其应用. 中国医学前沿杂志 (电子版), 2017, 9(10): 43-46.Pan WZ, Zhou DX, Ge JP. New understanding of mitral regurgitation mechanism and its application. Chin Med Front J (Electronic Edition), 2017, 9(10): 43-46.
9.	Di Mauro M, Cargoni M, Liberi R, et al. Mitral valve repair or replacement. How long is this feud to last? J Card Surg, 2022, 37(6): 1599-1601.
10.	Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: A 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828-1837.
11.	Lazam S, Vanoverschelde JL, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large, prospective, multicenter, international registry. Circulation, 2017, 135(5): 410-422.
12.	Can T, Kirov H, Caldonazo T, et al. Surgical mitral valve repair technique considerations based on the available evidence. Turk Gogus Kalp Damar Cerrahisi Derg, 2022, 30(2): 302-316.
13.	Campos-Arjona R, Rodríguez-Capitán J, Martínez-Carmona JD, et al. Prognosis for mitral valve repair surgery in functional mitral regurgitation. Ann Thorac Cardiovasc Surg, 2022, 28(5): 342-348.
14.	余森, 葛树明, 丁诗力, 等. 二尖瓣反流行成形术或置换术后左心结构与功能早中期对比研究. 中华胸心血管外科杂志, 2019, 35(10): 583-587.Yu S, Ge SM, Ding SL, et al. A comparative study of left heart structure and function in the early and middle stages after reverse mitral valve plasty or replacement. Chin J Thorac Cardiovasc Surg, 2019, 35(10): 583-587.
15.	Gaasch WH, Meyer TE. Secondary mitral regurgitation (part 2): Deliberations on mitral surgery and transcatheter repair. Heart, 2018, 104(8): 639-643.
16.	Shah N, Madhavan MV, Gray WA, et al. Prediction of death or HF hospitalization in patients with severe FMR: The COAPT risk score. JACC Cardiovasc Interv, 2022, 15(19): 1893-1905.
17.	Petrus AHJ, Dekkers OM, Tops LF, et al. Impact of recurrent mitral regurgitation after mitral valve repair for functional mitral regurgitation: Long-term analysis of competing outcomes. Eur Heart J, 2019, 40(27): 2206-2214.
18.	Kawamoto N, Fukushima S, Kainuma S, et al. Mitral valve surgery for atrial functional mitral regurgitation: Predicting recurrent mitral regurgitation and mid-term outcome. Gen Thorac Cardiovasc Surg, 2022, 70(9): 761-769.
19.	Imielski B, Malaisrie SC, Pham DT, et al. The impact of intraoperative residual mild regurgitation after repair of degenerative mitral regurgitation. J Thorac Cardiovasc Surg, 2021, 161(4): 1215-1224.

1. Izumi C, Eishi K, Ashihara K, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J, 2020, 84(11): 2037-2119.
2. Abe Y, Takahashi Y, Shibata T. A new disease entity: Atrial functional mitral regurgitation. J Cardiol, 2021, 77(6): 565-569.
3. Vajapey R, Kwon D. Guide to functional mitral regurgitation: A contemporary review. Cardiovasc Diagn Ther, 2021, 11(3): 781-792.
4. Ailawadi G, Lim DS, Mack MJ, et al. One-year outcomes after MitraClip for functional mitral regurgitation. Circulation, 2019, 139(1): 37-47.
5. 叶蕴青, 吴永健. 功能性二尖瓣反流的治疗进展. 中国心血管杂志, 2015, 20(6): 480-482.Ye YQ, Wu YJ. Progress in the treatment of functional mitral regurgitation. Chin J Cardiovasc Sci, 2019, 139(1): 37-47.
6. Wagner CM, Brescia AA, Watt TMF, et al. Surgical strategy and outcomes for atrial functional mitral regurgitation: All functional mitral regurgitation is not the same! J Thorac Cardiovasc Surg, 2022, 167(2): 647-655.
7. Watanabe N, Maltais S, Nishino S, et al. Functional mitral regurgitation: Imaging insights, clinical outcomes and surgical principles. Prog Cardiovasc Dis, 2017, 60(3): 351-360.
8. 潘文志, 周达新, 葛均波. 二尖瓣反流机制的新认识及其应用. 中国医学前沿杂志 (电子版), 2017, 9(10): 43-46.Pan WZ, Zhou DX, Ge JP. New understanding of mitral regurgitation mechanism and its application. Chin Med Front J (Electronic Edition), 2017, 9(10): 43-46.
9. Di Mauro M, Cargoni M, Liberi R, et al. Mitral valve repair or replacement. How long is this feud to last? J Card Surg, 2022, 37(6): 1599-1601.
10. Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: A 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828-1837.
11. Lazam S, Vanoverschelde JL, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large, prospective, multicenter, international registry. Circulation, 2017, 135(5): 410-422.
12. Can T, Kirov H, Caldonazo T, et al. Surgical mitral valve repair technique considerations based on the available evidence. Turk Gogus Kalp Damar Cerrahisi Derg, 2022, 30(2): 302-316.
13. Campos-Arjona R, Rodríguez-Capitán J, Martínez-Carmona JD, et al. Prognosis for mitral valve repair surgery in functional mitral regurgitation. Ann Thorac Cardiovasc Surg, 2022, 28(5): 342-348.
14. 余森, 葛树明, 丁诗力, 等. 二尖瓣反流行成形术或置换术后左心结构与功能早中期对比研究. 中华胸心血管外科杂志, 2019, 35(10): 583-587.Yu S, Ge SM, Ding SL, et al. A comparative study of left heart structure and function in the early and middle stages after reverse mitral valve plasty or replacement. Chin J Thorac Cardiovasc Surg, 2019, 35(10): 583-587.
15. Gaasch WH, Meyer TE. Secondary mitral regurgitation (part 2): Deliberations on mitral surgery and transcatheter repair. Heart, 2018, 104(8): 639-643.
16. Shah N, Madhavan MV, Gray WA, et al. Prediction of death or HF hospitalization in patients with severe FMR: The COAPT risk score. JACC Cardiovasc Interv, 2022, 15(19): 1893-1905.
17. Petrus AHJ, Dekkers OM, Tops LF, et al. Impact of recurrent mitral regurgitation after mitral valve repair for functional mitral regurgitation: Long-term analysis of competing outcomes. Eur Heart J, 2019, 40(27): 2206-2214.
18. Kawamoto N, Fukushima S, Kainuma S, et al. Mitral valve surgery for atrial functional mitral regurgitation: Predicting recurrent mitral regurgitation and mid-term outcome. Gen Thorac Cardiovasc Surg, 2022, 70(9): 761-769.
19. Imielski B, Malaisrie SC, Pham DT, et al. The impact of intraoperative residual mild regurgitation after repair of degenerative mitral regurgitation. J Thorac Cardiovasc Surg, 2021, 161(4): 1215-1224.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid- and long-term efficacy of mitral valve plasty versus replacement in the treatment of functional mitral regurgitation: A 10-year single-center outcome

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