Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes

Background Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is often treatable by surgical repair. However, the very long-term (>10-year) durability of repair in both anterior leaflet prolapse (AL-MVP) and posterior leaflet prolapse (PL-MVP) is unknown. Methods and Results In 917 patients (aged 65±13 years, 68% male), surgical correction of severe isolated MR due to MVP (679 repairs and 238 replacements [MVRs]) was performed between 1980 and 1995. Survival after repair was better than survival after MVR for both PL-MVP (at 15 years, 41±5% versus 31±6%, respectively; P =0.0003) and AL-MVP (at 14 years, 42±8% versus 31±5%, respectively; P =0.003). In multivariate analysis adjusting for predictors of survival, repair was independently associated with lower mortality in PL-MVP (adjusted risk ratio [RR] 0.61, 95% CI 0.44 to 0.85; P =0.0034) and in AL-MVP (adjusted RR 0.67, 95% CI 0.47 to 0.96; P =0.028). The reoperation rate was not different after repair or MVR overall (at 19 years, 20±5% for repair versus 23±5% for MVR; P =0.4) or separately in PL-MVP ( P =0.3) or AL-MVP ( P =0.3). However, the reoperation rate was higher after repair of AL-MVP than after repair of PL-MVP (at 15 years, 28±7% versus 11±3%, respectively; P =0.0006). From the 1980s to the 1990s, the RR of reoperation after repair of AL-MVP versus PL-MVP did not change (RR 2.5 versus 2.7, respectively; P =0.58), but the absolute rate of reoperation decreased similarly in PL-MVP and AL-MVP (at 10 years, from 10±3% to 5±2% and from 24±6% to 10±2%, respectively; P =0.04). Conclusions In severe MR due to MVP, mitral valve repair compared with MVR provides improved very long-term survival after surgery for both AL-MVP and PL-MVP. Reoperation is similarly required after repair or replacement but is more frequent after repair of AL-MVP. Recent improvement in long-term durability of repair suggests that it should be the preferred mode of surgical correction of MVP whether it affects anterior or posterior leaflets and is an additional incentive for early surgery of severe MR due to MVP.

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Transient systolic anterior motion after mitral valve repair: Does it affect long-term outcomes?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.10.099 ◽

2015 ◽

Vol 149 (2) ◽

pp. 477-478

Author(s):

Niv Ad

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Systolic Anterior Motion ◽

Valve Repair ◽

Long Term Outcomes

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Long-term outcomes of concomitant aortic and mitral valve repair

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2013.10.016 ◽

2014 ◽

Vol 148 (2) ◽

pp. 454-460 ◽

Cited By ~ 8

Author(s):

Hunaid A. Vohra ◽

Robert N. Whistance ◽

Jawad Hechadi ◽

Laurent de Kerchove ◽

Hannah Fuller ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Long Term Outcomes

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Early and long-term outcomes of mitral valve repair for Barlow’s disease: a single-centre 16-year experience†

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx423 ◽

2018 ◽

Vol 26 (5) ◽

pp. 783-789 ◽

Cited By ~ 2

Author(s):

Anton Tomšič ◽

Yasmine L Hiemstra ◽

Stephanie L van der Pas ◽

Hein Putter ◽

Michel I M Versteegh ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Long Term Outcomes ◽

Single Centre ◽

Barlow’S Disease

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Mitral valve repair for posterior leaflet prolapse: Long‐term comparison of loop implantation vs resection

Journal of Cardiac Surgery ◽

10.1111/jocs.14388 ◽

2019 ◽

Vol 35 (1) ◽

pp. 11-20 ◽

Cited By ~ 1

Author(s):

Ayse Cetinkaya ◽

Stephanie Bär ◽

Stefan Hein ◽

Karin Bramlage ◽

Peter Bramlage ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Posterior Leaflet ◽

Valve Repair ◽

Leaflet Prolapse

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Long-term outcomes of rheumatic mitral valve repair: Is it worthwhile to do it?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320970769 ◽

2020 ◽

pp. 021849232097076

Author(s):

Somchai Waikittipong

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Young Patients ◽

Class Iii ◽

Valve Repair ◽

Long Term Outcomes ◽

Actuarial Survival

Aim This retrospective study was undertaken to evaluate the long-term outcomes of mitral valve repair in rheumatic patients. Methods From 2003 to 2019, 151 patients (mean age 26.5 ± 14.9 years; 68.9% female) underwent mitral valve repair. Fifty-three (35.1%) had atrial fibrillation, and 79 (52.3%) were in New York Heart Association class III/IV. Pure mitral regurgitation was present in 109 (72.2%) patients, pure stenosis in 9 (6%), and mixed regurgitation and stenosis in 33. Results Three (2%) patients died postoperatively and 4 (2.6%) were lost during follow-up. Mean follow-up was 90.5 ± 55.6 months. There were 22 (14.8%) late deaths. Actuarial survival at 5, 10, and 15 years was 90.7% ± 2.5%, 83.5% ± 3.6%, and 76.5 ± 6.1%, respectively. Twelve (8.5%) patients underwent reoperation. Freedom from reoperation at 5, 10, and 15 years was 96.1% ± 1.7%, 89.8% ± 3.2%, and 82.3% ± 6.1%, respectively. Forty-two (29.2%) patients developed recurrent mitral regurgitation. Freedom from recurrence of mitral regurgitation at 5, 10, and 15 years was 70.9% ± 4.3%, 56% ± 5.9%, and 53.3% ± 6.4%, respectively. Eighty-one (56.6%) patients were and free from all events during follow-up. Freedom from all events at 5, 10, and 15 years was 64.8% ± 4.1%, 48.6% ± 5.3%, and 43.7% ± 5.8%, respectively. Conclusions Although rheumatic mitral valve repair is associated with late recurrence of mitral regurgitation, it has benefits in selected patients, especially children and young patients who want to avoid the lifelong risks of anticoagulation. Long-term follow-up is essential in these patients.

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