Long-Term Outcomes of Mitral Valve Surgery for Mitral Regurgitation in Patients With Marfan Syndrome ― A Retrospective Single-Center Study ―

Background: Because data on the long-term outcomes of surgical treatment for mitral valve (MV) disease in patients with Marfan syndrome remain limited, we compared the long-term outcomes after MV repair or replacement. Methods and Results: We retrospectively evaluated 33 patients with Marfan syndrome who underwent mitral regurgitation (MR) surgery between November 1984 and July 2023. Patients were categorized into MV repair (n=19) and MV replacement (n=14) groups. Outcomes included survival, recurrent MR (≥grade 3), reoperation, and major adverse cardiac or cerebrovascular events. No in-hospital deaths occurred in either group. Overall survival at 1, 5, and 10 years, respectively, was 100%, 100%, and 70% after repair, and 100%, 100%, and 91.7%after replacement (P=0.48). Freedom from recurrent MR (≥grade 3) at 10 years was 90.9% after repair, and 82.5% after replacement (P=0.30). Freedom from mitral reoperation at 10 years was 94.1% after repair, and 91.7% after replacement (P=0.34). All reoperations in the replacement group were performed for paravalvular leak, whereas recurrent MR subsequent to repair was infrequent and clinically stable. Conclusions: Acceptable outcomes were observed after both MV repair and MV replacement in patients with Marfan syndrome. The modes of failure differed between procedures: recurrent MR occurred after repair, whereas paravalvular leak required reoperation after replacement. These descriptive observations may help inform surgical decision-making regarding potential procedure-specific failure patterns.