Practical experience and clinical results of reconstructive surgical correction of primary and secondary mitral regurgitation

Authors

DOI:

https://doi.org/10.14739/2310-1210.2025.2.322630

Keywords:

mitral regurgitation, transthoracic echocardiography, median sternotomy, artificial circulation, mitral annuloplasty, restoration of mitral valve competence

Abstract

Mitral regurgitation (MR) is the most common valvular anomaly worldwide, affecting more than 2 % of the population. Mitral valve surgery is indicated in symptomatic patients with severe insufficiency and asymptomatic individuals with left ventricular systolic dysfunction, pulmonary hypertension, or atrial fibrillation.

Aim. Improving the immediate and long-term outcomes after cardiac surgery by demonstrating our own experience and analyzing the results of plastic correction for mitral regurgitation in patients with primary and secondary heart defects.

Materials and methods. A single-center retrospective observational study of clinical data on 107 consecutive patients with mitral valve insufficiency who underwent a surgery at Zaporizhzhia Regional Clinical Hospital between 01.01.2020 and 31.12.2024 was conducted. Depending on clinical and etiological factors, the structure of patients with MR was defined as follows: primary MR – 47.66 % (n = 51), secondary MR – 52.34 % (n = 56) cases. The mean age of patients was 62.2 ± 11.2 years. The studied patients had a sex distribution of 40 (37.38 %) female and 67 (62.62 %) male individuals.

Results. The length of stay in the intensive care unit was 4.6 ± 1.2 days. The total hospital length of stay was 17.4 ± 9.0 days. The hospital mortality rate for primary MR was 1.87 % (n = 2) and 7.48 % (n = 7) for secondary. At the time of discharge, 18.56 % (n = 18) of patients had no residual MR. In 51.54 % (n = 50) of patients, minimal (trivial) MR was detected, in 18.56 % (n = 18) – mild MR, and in 11.34 % (n = 11) – moderate MR. Thus, reconstructive plastic interventions on the MV were successfully performed in 90.65 % (n = 97) of patients. Freedom from reoperation in the early postoperative period was 100 %, freedom from moderate or severe MR in the early postoperative period was 88.66 % (86 out of 97 patients at the time of discharge).

Conclusions. Modern surgical repair techniques for mitral valve reconstruction demonstrate highly effective and safe treatment of patients with primary and secondary mitral insufficiency. Transthoracic echocardiography is the most common and necessary powerful imaging method for the diagnosis of mitral regurgitation.

Author Biographies

V. V. Osaulenko, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, Associate Professor of the Department of Hospital Surgery

V. O. Hubka, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, DSc, Professor, Head of the Department of Hospital Surgery

K. O. Chmul, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, Assistant of the Department of Hospital Surgery

S. Yu. Nakonechnyi, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, Associate Professor of the Department of Propaedeutics of Internal Medicine, Radiation Diagnostics and Radiation Therapy

R. I. Budahov, Zaporizhzhia State Medical and Pharmaceutical University

MD, Senior Laboratory Assistant of the Department of Hospital Surgery

References

  1. Aluru JS, Barsouk A, Saginala K, Rawla P, Barsouk A. Valvular heart disease epidemiology. Med Sci. 2022;10(2):32. doi: https://doi.org/10.3390/medsci10020032
  2. Douedi S, Douedi H. Mitral regurgitation. [Updated 2024 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553135
  3. Roth GA, Mensah GA, Fuster V. The global burden of cardiovascular diseases and risks: a compass for global action. J Am Coll Cardiol. 2020;76(25):2980-1. doi: https://doi.org/10.1016/j.jacc.2020.11.021
  4. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and beyond. J Am Coll Cardiol. 2019;74(20):2529-32. doi: https://doi.org/10.1016/j.jacc.2019.10.009
  5. Henning RJ. The current diagnosis and treatment of high-risk patients with chronic primary and secondary mitral valve regurgitation. Future Cardiol. 2022;18(1):67-87. doi: https://doi.org/10.2217/fca-2020-0189
  6. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227. doi: https://doi.org/10.1161/CIR.0000000000000923
  7. Jung JC, Jang MJ, Hwang HY. Meta-analysis comparing mitral valve repair versus replacement for degenerative mitral regurgitation across all ages. Am J Cardiol. 2019;123(3):446-53. doi: https://doi.org/10.1016/j.amjcard.2018.10.024
  8. Dietze Z, Marin-Cuartas M, Berkei L, De La Cuesta M, Otto W, Pfannmüller B, et al. Mitral valve replacement versus repair for severe mitral regurgitation in patients with reduced left ventricular ejection fraction. JTCVS Open. 2024;22:191-207. doi: https://doi.org/10.1016/j.xjon.2024.07.021
  9. Gammie JS, Chikwe J, Badhwar V, Thibault DP, Vemulapalli S, Thourani VH, et al. Isolated mitral valve surgery: the Society of Thoracic Surgeons Adult Cardiac Surgery Database analysis. Ann Thorac Surg. 2018;106(3):716-27. doi: https://doi.org/10.1016/j.athoracsur.2018.03.086
  10. David TE, David CM, Tsang W, Lafreniere-Roula M, Manlhiot C. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse. J Am Coll Cardiol. 2019;74(8):1044-53. doi: https://doi.org/10.1016/j.jacc.2019.06.052
  11. Kawajiri H, Schaff HV, Dearani JA, Daly RC, Greason KL, Arghami A, et al. Clinical outcomes of mitral valve repair for degenerative mitral regurgitation in elderly patients. Eur J Cardiothorac Surg. 2022;62(2):ezac299. doi: https://doi.org/10.1093/ejcts/ezac299
  12. Noly PE, Pagani FD, Obadia JF, Bouchard D, Bolling SF, Ailawadi G, et al. The role of surgery for secondary mitral regurgitation and heart failure in the era of transcatheter mitral valve therapies. Rev Cardiovasc Med. 2022;23(3):87. doi: https://doi.org/10.31083/j.rcm2303087
  13. Grinberg D, Uhlrich W, Thivolet S, Buzzi R, Rioufol G, Obadia JF, et al. The unfinished saga of invasive procedures for secondary mitral regurgitation. Ann Cardiothorac Surg. 2021;10(1):66-74. doi: https://doi.org/10.21037/acs-2020-mv-15
  14. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi: https://doi.org/10.1093/eurheartj/ehab395
  15. Salik I, Lee LS, Sharma S, Widrich J. Mitral valve repair. [Updated 2024 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549879/
  16. Andrási TB, Glück AC, Ben Taieb O, Talipov I, Abudureheman N, Volevski L, et al. Outcome of surgery for ischemic mitral regurgitation depends on the type and timing of the coronary revascularization. J Clin Med. 2023;12(9):3182. doi: https://doi.org/10.3390/jcm12093182
  17. Moroz VS, Lazoryshynets VV. [Analysis of echocardiography indicators depending on the type of surgical correction of the mitral valve in patients with ischemic heart disease]. Ukrainian Journal of Cardiovascular Surgery. 2024;32(3):45-50. Ukrainian. doi: https://doi.org/10.30702/ujcvs/24.32(03)/ML044-4550
  18. Hawary KM, Elghanam MA, Al-saiegh MT, Desokey AS, ElAasey SM, Abdallah AA, et al. Management of moderate ischemic mitral regurgitation in patients undergoing surgical revascularization. QJM. 2023;116(Suppl 1):hcad069.113. doi: https://doi.org/10.1093/qjmed/hcad069.113
  19. Dhaduk N, Chaus A, Williams D, et al. Secondary mitral regurgitation: diagnosis and management. US Cardiol Rev. 2024;18:e05. doi: https://doi.org/10.15420/usc.2022.34
  20. Luchynets OF, Lazoryshynets VV, Krykunov OA. [Clinical manifestations and results of reconstructive surgeries in patients with primary and secondary mitral insufficiency]. Zaporozhye medical journal. 2020;22(6):760-6. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2020.6.218401
  21. Deja MA, Malinowski M, Widenka K, Stożyński N, Bartuś K, Kapelak B, et al. Repair or replacement for secondary mitral regurgitation: results from Polish National Registry. Ann Thorac Surg. 2022;113(1):146-56. doi: https://doi.org/10.1016/j.athoracsur.2020.12.059

Downloads

Additional Files

Published

2025-04-29

How to Cite

1.
Osaulenko VV, Hubka VO, Chmul KO, Nakonechnyi SY, Budahov RI. Practical experience and clinical results of reconstructive surgical correction of primary and secondary mitral regurgitation. Zaporozhye Medical Journal [Internet]. 2025Apr.29 [cited 2026May21];27(2):110-7. Available from: https://zmj.zsmu.edu.ua/article/view/322630

Issue

Vol. 27 No. 2 (2025)

Section

Original research

License

Copyright (c) 2025 V. V. Osaulenko, V. O. Hubka, K. O. Chmul, S. Yu. Nakonechnyi, R. I. Budahov

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons