Mid-term results of mitral valve replacement and repair: current clinical experience, technical aspects, and risk factor analysis

Abstract

Aim: We evaluated the short- and mid-term results of mitral valve replacement (MVR) and mitral valve repair (MV-repair).

Methods: In total, 168 patients (mean age 67 ± 11 years) underwent MVR (n = 104) and MV-repair (n = 64). To treat posterior leaflet disease, MV-repair techniques included triangular or quadrangular resection (n = 38), P1-P2 plication (n = 4), side-to side P1-P2 (n = 1), posterior-medial commissure-plasty (n = 1), and annuloplasty (n = 20). A prosthetic ring was implanted in all patients. In the presence of degenerative disease involving the anterior leaflet, extensive myxomatous and/or prolapsing pathology of the entire valve, and/or rheumatic and endocarditis degeneration, surgical orientation was to perform MVR directly. When possible, the sub-valvular apparatus with its papillary muscle was partially preserved. The mean follow-up was 38 ± 22 months.

Results: Operative mortality (0.96% vs. 1.56%) and six-year survival (94% vs. 100%) were similar in MVR and MV-repair. The only independent predictor of late survival was advanced age at the operation (79.2 years vs. 66.4 years; P = 0.012). Freedom from redo-operation was 100%. Partial preservation of the sub-valvular apparatus with its papillary muscle during MVR allowed postoperatively a better left ventricular function with similar values achieved with MV-repair (P = 0.05), and it was a protective factor against the development of left ventricular dysfunction during follow-up (P = 0.01).

Conclusion: MVR and MV-repair are associated with satisfactory results in the short and medium term. MV-repair to treat posterior leaflet disease is associated with a stable and long-lasting result; MVR allows equally satisfactory results in the presence of more extensive and more complex mitral valve disease. Partial preservation of the sub-valvular apparatus favors a better left ventricular systolic function.

Keywords

Mitral valve repair / mitral valve replacement / mitral valve surgery and late survival

References

[1] Enriquez-Sarano M,Orszulak TA,Bailey KR.Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis.Circulation1995;91:1022-8

[2] Gillinov AM,Nowicki ER.Valve repair versus valve replacement for degenerative mitral valve disease.J Thorac Cardiovasc Surg2008;135:885-93, 893.e1-2

[3] Daneshmand MA,Rankin JS.Mitral valve repair for degenerative disease: a 20-year experience.Ann Thorac Surg2009;88:1828-37

[4] Mick SL,Gillinov AM.Mitral valve repair versus replacement.Ann Cardiothorac Surg2015;4:230-7 PMCID:PMC4533076

[5] Vahanian A,Andreotti F.Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS)Guidelines on the management of valvular heart disease (version 2012).Eur Heart J2012;33:2451-96

[6] Vahanian A,Praz F.ESC/EACTS Scientific Document Group, ESC Scientific Document Group2021 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J2021;ehab395

[7] Akins CW,Turina MI.Councils of the American Association for Thoracic Surgery, Society of Thoracic Surgeons, European Assoication for Cardio-Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve MorbidityGuidelines for reporting mortality and morbidity after cardiac valve interventions.J Thorac Cardiovasc Surg2008;135:732-8

[8] Lang RM,Devereux RB.American Society of Echocardiography's Nomenclature and Standards Committee, Task Force on Chamber Quantification, American College of Cardiology Echocardiography Committee, American Heart Association, European Association of Echocardiography, European Society of CardiologyRecommendations for chamber quantification.Eur J Echocardiogr2006;7:79-108

[9] Zoghbi W.Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography.J Am Soc Echocardiogr2003;16:777-802

[10] Nardi P,Russo M.Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement.J Thorac Dis2018;10:1490-9 PMCID:PMC5906273

[11] Schubert SA,Charles EJ.Mitral valve repair: the French correction versus the American correction.Surg Clin North Am2017;97:867-88 PMCID:PMC5567844

[12] McNeely CA.Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review.Curr Cardiol Rev2015;11:157-62 PMCID:PMC4356723

[13] Mohty D,Schaff HV,Tajik JA.Very long-term survival and durability of mitral valve repair for mitral valve prolapse.Circulation2001;104:I1-7

[14] Ling LH,Seward JB.Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study.Circulation1997;96:1819-25

[15] Nardi P,Scafuri A.Survival and durability of mitral valve repair surgery for degenerative mitral valve disease.J Card Surg2011;26:360-6

[16] Suri RM,Dearani JA.Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era.Ann Thorac Surg2006;82:819-26

[17] Gardner MA,Smith IR.Long-term results following repair for degenerative mitral regurgitation - analysis of factors influencing durability.Heart Lung Circ2019;28:1852-65

[18] Lazam S,Tribouilloy C.MIDA (Mitral Regurgitation International Database) InvestigatorsTwenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry.Circulation2017;135:410-22

[19] Hannan EL,Smith CR.Mitral valve repair versus replacement for patients with preserved left ventricular function without heart failure symptoms.J Thorac Cardiovasc Surg2019;157:1432-9.e2

[20] Suri RM,Dearani JA.Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse.J Thorac Cardiovasc Surg2009;137:1071-6