The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy is controversial. Mini-MVR may limit post-operative morbidity and mortality by minimizing recurrent MR. We hypothesized that minimally-invasive fibrillating mitral valve replacement (mini-MVR) with complete chordal sparing would offer a low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR.
Methods and Results
Between 1/06 - 8/09, 65 patients with LVEF ≤ 35% underwent mini-MVR. Demographic, echocardiographic, and clinical outcomes were analyzed.
Operative mortality compared to Society for Thoracic Surgery (STS)-predicted mortality was 6.2 versus 6.6%; 5.6 versus 7.4% among patients with LVEF ≤ 20%; and 8.3 versus 17.9% among patients with STS-predicted mortality of ≥ 10%. At median follow-up of 17 months there was no recurrent MR or change in LV dimensions or LVEF, but there was a decrease (p = 0.02) in right ventricular systolic pressure (RVSP). At the first post-operative visit and longest follow-up, NYHA class decreased from 3.0 ± 0.6 to 1.7 ± 0.7 and 2.0 ± 1.0, respectively (both p < 0.0001). Patients with LVEF ≤ 20% and LVEDD ≥ 6.5cm were more likely to meet a composite of death, transplant, or LV assist device insertion (p = 0.046).
Mini-MVR is safe in advanced cardiomyopathy, and resulted in no recurrent MR, stabilization of LVEF and LV dimensions, and a decrease in RVSP. This mini-MVR fibrillating technique can be used to address severe MR in patients with advanced cardiomyopathy.