Timing of Surgery in Patients with Severe Degenerative Mitral Regurgitation Due to Bileaflet Prolapse

BACKGROUND The purpose of this study was to evaluate the impact of surgical timing on patients with bileaflet prolapse. METHODS From 1/1/2016 to 7/1/2020, 250 adults underwent primary mitral valve surgery for severe mitral regurgitation (MR) due to bileaflet prolapse at Cleveland Clinic and were divided into an early surgery group (asymptomatic patients, no history of atrial fibrillation, left ventricle end-systolic diameter ≤40 mm, ejection fraction ≥60%, and pulmonary arterial systolic pressure ≤50 mmHg) and a late surgery group with ≥1 of these criteria. Longitudinal analysis of postoperative echocardiographic data from 601 transthoracic echocardiograms were used to assess durability of repair between early surgery (n=50) and late surgery (n=200) groups. RESULTS All patients underwent successful mitral valve repair (n=250; 100%). Minimally invasive approaches were used in 48% (n=24) of the early surgery group and 41% (n=82) of the late surgery group (P=.37). Anterior neochordae were required in the majority of patients (66% (n=54) vs. 60% (n=119); P=.40). There was no operative morality in this series. Five-year prevalence of ≥ 2+ MR was estimated at 20% in the early surgery group and 16% in the late group (P=.69). Freedom from reoperation at 5 years was 100% after early surgery and 97% after late surgery (P=.30). CONCLUSIONS Most patients with severe MR due to bileaflet prolapse underwent late surgery. Repair was 100% with similar complexity regardless of surgical timing. In the absence of symptoms and adverse remodeling, early surgery for severe MR due to bileaflet prolapse may be recommended at an experienced center.