Abstract 14907: Minimally Invasive Mitral Valve Annuloplasty Confers a Long-Term Survival Benefit Compared With State-Of-The-Art Treatment in Heart Failure Patients With Functional Mitral Regurgitation

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A14907
• Main Authors: Penicka, Martin, Kotrc, Martin, Ondrus, Tomas, Mo, Yujing, Casselman, Filip, Vanderheyden, Marc, Van Camp, Guy, Van Praet, Frank, Bartunek, Jozef
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11-11-2016
• ISSN: 0009-7322; 1524-4539

IntroductionData comparing the outcome of the minimally invasive surgical mitral valve annuloplasty (MVA) of isolated functional mitral regurgitation (FMR) with the state-of-the-art standards of care in systolic heart failure are not available.HypothesisWe tested the hypothesis that isolated MVA using the minimally invasive surgical approach will be independently associated with long-term survival benefit compared with the state-of-the-art conservative (CON) treatment in the propensity-matched high-risk patients with chronic systolic heart failure and symptomatic FMR.MethodsThe study population consisted of 312 consecutive patients (age 68.6± 10.8 years, 65.2% males) with stable LV systolic dysfunction, symptomatic FMR and previous heart failure hospitalization, who were followed in the heart failure clinic. A total of 158 patients underwent undersized MVA and 158 propensity-score matched patients were treated conservatively. A concomitant MAZE was performed in 53 (34%) patients.ResultsIn the MVA group, the periprocedural and the 30-day mortality were 1.3% and 5.7%, respectively. During the median follow-up of 6.3 years (IQR 3.5-8.2 years) a total of 12 (23%), 51 (49%) and 94 (60%) died in the MVA with MAZE, MVA without MAZE and the CON group, respectively (p<0.001) (Figure 1). In Cox regression analysis, age, MVA both with and without MAZE emerged as independent predictors of all-cause mortality (all p < 0.05). MVA was associated with significantly greater symptomatic improvement and reduction of FMR than the conservative treatment (both p<0.001). Reverse LV remodeling was observed only in the MVA combined with MAZE group (p<0.01).ConclusionsIn high-risk heart failure patients with symptomatic FMR, minimally invasive MVA, in particular in combination with MAZE, confers an independent long-term survival benefit compared with the state-of-the-art treatment.