TWO DECADES OF MITRAL VALVE REPAIR IN PATIENTS WITH SMALL CALCIFICATIONS: LONG-TERM OUTCOMES AND PROGNOSTIC FACTORS

Introduction: Mitral valve calcifications increase the complexity of valvular repair. Major calcifications have a known impact on the outcomes, while minor calcifications are less studied. We aim to define the role of minor mitral valve calcification on long term results of valvular repair. Methods: Retrospective study on patients who underwent mitral valve repair between 2001 and 2010. Patients who had a degenerative mitral valve disease, minor calcification at pre-operative echocardiogram confirmed at surgical inspection and no employment of decalcification techniques were included. A control group was selected using a 1:2 match using propensity score. Kaplan-Meier curves estimated long term survival and mitral valve events (recurrent mitral regurgitation>2+, mitral valve reintervention, endocarditis and cardiac death. Cox- model estimated the unadjusted and adjusted hazard ratio. Results: A total of 1052 patients underwent mitral valve repair and 42(3.99%) met the inclusion criteria. 76 patients were selected to form the Control Group. The only significant preoperative difference among the two groups was the presence of coronaropathy, which was more common in the group with mitral calcification (p-value 0.0283). At follow-up, 30 patients developed the study endpoint (Control Group: n=13, 17.1%; Group with mitral calcification: n=17, 40.5%; p=0.0053). The 19-year survival by Kaplan–Meier analysis showed that mitral valve calcification is associated with a worse survival (HR: 2.538 [1.520-4.238], p=0.0004), even after adjusting for preoperative coronary disease. Conclusions: Minor mitral calcifications are associated with a worse outcome, even after adjusting for preoperative coronary disease. Minor calcification should be taken into account when planning surgery and follow up.