Mitral valve Repair vs Replacement for ischemic mitral regurgitation - Sheba experience

Introduction:

Ischemic mitral regurgitation (IMR) worsens heart failure and increases mortality. Surgery is recommended for severe mitral regurgitation (MR) with ongoing symptoms despite optimal medical therapy, but guidelines don’t specify whether mitral valve repair (MVr) or replacement (MVR) is superior.

Here, we share our experience in treating IMR.

Methods:

Between February 2004 and October 2024, data from 230 patients with ischemic MR who underwent mitral valve surgery were analyzed. The MVR group had 100 patients, and the MVr group had 130, including combined procedures.(excluding REDO) The average age was 65 ± 10 years for MVr and 70 ± 9 years for MVR (P=0.002), with 75% males and a mean EF of 42% ± 12 in both groups.The mean EURO score was 7.6± 4 for MVR and 6 ± 4 for MVr (p=0.001).

Results:

Hospital mortality was 6% for MVR and 7.5% for MVr. One-year, five-year, and ten-year mortality rates were 12%, 27%, and 50% for MVR, compared to 11.5%, 23%, and 40% for MVr, respectively. Overall mortality was 65% for MVR and 55% for MVr (P = 0.09). Echocardiographic follow-up after 4 years revealed a moderate or worse MR recurrence in 9.5% of the MVr group (P = 0.04), with 6 patients requiring reoperation with REDO MVR and one patient receiving an LVAD.

Conclusion:

Our analysis showed that while older patients underwent MVR more often than MVr, mortality rates were similar up to 5 years. However, it was not statistically significant; there is a sliding scale with a survival benefit for mitral valve repair beyond 5 years.

MR recurrence was more common in the MVr group, potentially requiring reoperation, which increases mortality risk.

Given the complexity of ischemic MR, further research is needed to identify the best-individualized treatment approach to optimize the survival and quality of life of IMR patients.