Long-term echocardiographic evaluation of asymptomatic patients undergoing minimally invasive valve repair for severe primary mitral regurgitation

Abstract

Background: Asymptomatic patients with newly diagnosed severe primary mitral regurgitation (MR) may not be candidates for surgery according to clinical guidelines.

Aims: We aimed to determine whether asymptomatic patients with severe primary MR benefit from minimally invasive mitral valve repair.

Methods: This prospective registry study assessed consecutive asymptomatic patients who underwent mitral valve repair using right minithoracotomy. Left ventricular ejection fraction, end‑diastolic and end‑‑systolic volumes, end‑diastolic and end‑systolic diameters, as well as left atrial (LA) area and volume were measured. Major adverse cardiovascular and cerebrovascular events (MACCEs) were assessed at 6, 12, and 24 months after surgery.

Results: The study included 114 patients, of whom 16 (14%) were lost to follow‑up (except the endpoint of death). No deaths were reported during follow‑up. A comparison of median echocardiographic parameters at baseline and 24 months revealed significant reverse remodeling: left ventricular ejection fraction, 68% vs 60% (P < 0.001); end‑diastolic volume, 165 cm3 vs 107.5 cm3 (P < 0.001); end‑systolic volume, 51 cm3 vs 43.5 cm3 (P = 0.02), end‑diastolic diameter, 58 mm vs 49 mm (P < 0.001); end‑systolic diameter, 35 mm vs 30 mm (P < 0.001); LA area, 26 cm2 vs 18 cm2 (P < 0.001); and LA volume, 96 cm3 vs 49.5 cm3(P < 0.001). There were 9 MACCEs (9.2%): 2 reoperations (2%), 1 hospitalization for heart failure (1%), and 6 cases of new‑onset atrial fibrillation (6.1%).

Conclusions: Minimally invasive mitral valve repair is safe and effective in asymptomatic patients with severe primary MR. It should be recommended regardless of ventricular and atrial dimensions.