Outcomes of Mitral Valve Intervention for Patients with Bileaflet Mitral Valve Prolapse and Preoperative Ventricular Arrhythmias.

Bileaflet mitral valve (MV) prolapse may be associated with ventricular arrhythmias and cardiac arrest. Given the paucity of data analyzing the role of MV interventions, we analyzed outcomes of MV surgery in patients with bileaflet MV prolapse and preoperative ventricular arrhythmias. Between 1994 and 2018, 30 adult patients with bileaflet MV prolapse, severe MV regurgitation, and documented preoperative ventricular arrhythmias underwent MV operation at our institution. Ventricular arrhythmia was defined as ventricular tachycardia, ventricular fibrillation, cardiac arrest, or bigeminy. Pre- and postoperative ventricular arrhythmias and mortality were identified from medical record review. Median age was 51 years (IQR: 41.2, 59.5), and 20 (66.7%) patients were female. The most common preoperative arrhythmia was ventricular tachycardia (73%), followed by ventricular fibrillation and cardiac arrest. Most patients (N=28, 93.3%) underwent bileaflet MV repair, and 2 (6.7%) underwent MV replacement. There was no 30-day mortality. Ventricular arrhythmias did not recur postoperatively in 19 patients, and three patients with preoperative cardiac arrest improved without further cardiac arrest episodes but had ventricular tachycardia. The 1-year estimate of freedom from ventricular arrhythmia recurrence was 70%. Patients with recurrence were older and had longer delays between arrhythmia diagnosis and surgical referral. Higher body mass index and lower preoperative ejection fraction were associated with increased recurrence risk. In conclusion, surgical correction of bileaflet MV prolapse for severe MV regurgitation with preoperative ventricular arrhythmias can be performed safely. Although the majority of patients experienced a sustained reduction in arrhythmia burden postoperatively, recurrence was observed in a subset. Therefore, patients should be counseled regarding ongoing medical management and the possibility of recurrence despite correction of MV regurgitation.