Mitral Valve Repair for Degenerative MR With Moderate or Less Tricuspid Regurgitation: 2-Year Outcomes From a Multicenter Echocardiographic Core Laboratory-Adjudicated Cohort.

Abstract

Key indicators of the quality of mitral valve (MV) repair for degenerative mitral regurgitation (DMR) are the presence and degree of recurrent (mitral regurgitation (MR) during follow-up, but few studies have provided longitudinal echocardiographic core laboratory-adjudicated data. The purpose of this study was to evaluate 2-year survival and MR recurrence in patients who underwent MV repair for DMR with concomitant tricuspid valve (TV) disease between 2016 and 2018. This is a post hoc analysis of outcomes from a randomized trial (N = 401; 39 sites) evaluating the effects of TV repair during MV surgery for patients with DMR and moderate or less tricuspid regurgitation. Eighty-seven patients (21.7%) were excluded because they underwent MV replacement (32 planned and 9 conversions) or did not have isolated DMR or evaluable echocardiographic data during 2 years. The primary endpoint was a composite of the incidence of all-cause mortality, recurrent severe MR, or MV reoperation (ie, treatment failure) during 2 years. Multivariable modeling identified risk factors for recurrent MR. Among 314 eligible patients (median age: 67.4; female: 24.2%), 1.0% (3 of 307) had moderate MR and 0.7% (2 of 307) had severe MR at discharge. Thirty-day all-cause mortality rate was 1.0%. At 2 years, 3.5% (11 of 314) had died, and 2.2% (7 of 314) had MV reoperation. Among 295 survivors free of MV reoperation with evaluable echocardiograms, 9.2% (27 of 295) had moderate MR, 1.4% (4 of 295) had severe MR, and 2.5% (7 of 275) had a mean MV gradient >5 mm Hg. The incidence of death, MV reoperation, or severe MR during 2 years was 8.0% (25 of 313). Patients with anterior or bileaflet MV pathology were at higher risk for treatment failure compared with patients with posterior leaflet pathology (OR: 2.48; 95% CI: 1.09-5.68; P = 0.03). In this international trial with echocardiographic core laboratory adjudication, the rate of survival free from MV reoperation or any episode of severe MR during 2 years was 92% in patients with DMR and concomitant TV disease. These outcomes show that surgical repair achieves high success and durability during 2 years in these patients, providing a contemporary benchmark for clinical decision-making and future trials. (Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery; NCT02675244).