Functional mitral regurgitation (FMR) is associated with increased mortality and has been considered a marker for advanced heart disease, yet the value of mitral valve repair (MVr) in this population remains unclear. This study aims to evaluate the impact of reducing FMR burden through surgical MVr on survival. Patients with severe FMR who underwent MVr with an undersized, complete, rigid, annuloplasty between 2004 and 2017 were assessed (n = 201). Patients were categorized based on grade of recurrent FMR (0-4). Time-to-event Kaplan-Meier estimations of freedom from death or reoperation were performed using the log-rank test. Cox proportional hazards models evaluated all-cause mortality and reported in hazards ratios (HR) and 95% confidence intervals (CI). Patients were categorized by postoperative recurrent FMR: 45% (91/201) of patients had grade 0, 29% (58/201) grade 1, 20% (40/201) grade 2, 2% (4/201) grade 3%, and 4% (8/201) grade 4. The cumulative incidence of reoperation with death as a competing risk was higher in patients with grades ≥3 recurrent FMR compared to grades ≤2 (44.6% vs 14.6%, subhazard ratio 3.69 [95% CI, 1.17-11.6]; P = 0.026). Overall freedom from death or reoperation was superior for recurrent FMR grades ≤2 compared to grades ≥3 (log-rank P < 0.001). Increasing recurrent FMR grade was independently associated with mortality (HR 1.30 [95% CI, 1.07-1.59] P = 0.009). Reduced postoperative FMR grade resulted in an incrementally lower risk of death or reoperation after MVr. These results suggest that achieving a durable reduction in FMR burden improves long-term survival.

功能性二尖瓣反流 (FMR) 与死亡率增加相关，并被认为是晚期心脏病的标志，但二尖瓣修复 (MVr) 在该人群中的价值仍不清楚。本研究旨在评估通过手术 MVr 减轻 FMR 负担对生存的影响。对 2004 年至 2017 年间接受过小尺寸、完整、刚性瓣环成形术的 MVr 的严重 FMR 患者进行了评估 (n = 201)。根据复发 FMR 的等级 (0-4) 对患者进行分类。使用对数秩检验对无死亡或再手术的发生时间进行 Kaplan-Meier 估计。 Cox 比例风险模型评估了全因死亡率，并以风险比 (HR) 和 95% 置信区间 (CI) 进行报告。根据术后复发 FMR 对患者进行分类：45% (91/201) 的患者为 0 级、29% (58/201) 1 级、20% (40/201) 2 级、2% (4/201) 3 级% 和 4% (8/201) 4 级。与 ≤2 级相比，复发性 FMR ≥3 级的患者以死亡作为竞争风险的再手术累积发生率较高（44.6% vs 14.6%，亚危险比 3.69 [ 95% CI，1.17-11.6]；P  = 0.026）。复发性 FMR 等级≤2 级的总体免于死亡或再手术的情况优于等级≥3 级的患者（对数秩P  < 0.001）。复发性 FMR 等级的增加与死亡率独立相关（HR 1.30 [95% CI，1.07-1.59] P  = 0.009）。术后 FMR 等级降低导致 MVr 后死亡或再次手术的风险逐渐降低。这些结果表明，实现 FMR 负担的持久减少可以改善长期生存。