Predictors and prognosis of mild regurgitation after rheumatic mitral valve repair: A dual-center cohort analysis on the basis of cardiac computed tomography.

Abstract

Rheumatic mitral disease remains a significant health issue, especially in developing regions. Although mitral valve (MV) repair improves outcomes, residual mild mitral regurgitation (MR) is common. This study aims to identify clinical and anatomical factors associated with residual mild MR after MV repair and to assess its impact on MR progression and survival. A dual-center, retrospective cohort study was undertaken of 580 patients with rheumatic mitral disease who underwent MV repair successfully at 2 high-volume centers in China. Patients were classified as having no MR (n = 371) or residual mild MR (n = 209) on the basis of postoperative echocardiography. Cardiac computed tomography was used to assess MV anatomy and calcification. Logistic regression identified factors associated with residual mild MR. Long-term follow-up analyzed MR progression and survival, with propensity score matching to adjust for confounders. The mean age was 57.6 ± 7.5 years, and 73.8% were female. Patients with residual mild MR exhibited greater rates of MV calcification (56.0% vs 43.9%, P = .007) and subvalvular fusion (27.3% vs 19.7%, P = .045). Atrial fibrillation, systolic pulmonary artery pressure, calcification volume, and papillary muscle or chordae tendineae fusion were independently associated with residual mild MR. After 7 years, the residual mild MR group had lower freedom from progression to moderate/severe MR (66.2% vs 84.9%, P = .017) but no difference in survival (97.1% vs 96.7%, P = .98). Residual mild MR after MV repair is associated with an increased risk of MR progression but does not impact long-term survival during limited follow-up. Preoperative cardiac computed tomography provides valuable guidance by identifying patients at greater risk for residual mild MR.