Survival and Durability of Mitral Valve Repair Surgery for Degenerative Mitral Valve Disease

AIM OF THE STUDY: To evaluate the results after standardized techniques of mitral valve repair (MVr) for treatment of degenerative mitral regurgitation (MR) and to analyze risk factors for late outcomes. METHODS: Two hundred and sixty-one patients (mean age 63 ± 12 years) underwent MVr between January 1999 and January 2010 for degenerative MR. In the last five years, all repair techniques were performed routinely using annuloplasty prosthetic ring, with or without quadrangular or triangular resection of posterior leaflet and/or edge-to-edge technique as always indicated by intraoperative transesophageal echocardiography. Mean follow-up (99% complete) was 54 ± 38 (range, 6 to 137) months. RESULTS: Operative mortality was 0.8% (2/261), 10-year actuarial survival 89%± 3%. At 10 years of follow-up freedom from cardiac death was 94%± 2.6%, from reoperation 95%± 2.4%, from thromboembolism 96%± 2.1%, and from endocarditis 100%. Independent predictor of late all-causes mortality was advanced age at operation (71 ± 10 years vs. 62 ± 12 years, p = 0.0068). Late progression to moderate or severe MR was observed in 12/256 patients (4.7%). Independent predictor of late progression to moderate or severe MR was annuloplasty without the use of prosthetic ring (p = 0.04). Reoperation was required in six patients (2.3%). Follow-up echocardiography showed improvement of MR, left ventricular end-diastolic and end-systolic diameters, left atrial diameter, and systolic pulmonary artery pressure (p < 0.0001 for all comparisons with preoperative values). CONCLUSIONS: MVr is a low-risk, durable surgical procedure. Standardized techniques, with the routine use of prosthetic ring, improve late results.