Abstract 11496: Long-Term Results (Up to 18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation: Implications for the Percutaneous Approach
OBJECTIVE: To assess the long-term results of the edge-to-edge (EE) mitral repair without annuloplasty in patients with degenerative MR.
METHODS: From 1993 to 2002, 61 patients (age 64±12.1 years, EF 57±8.3%) with severe degenerative MR were treated with an isolated EE suture without any annuloplasty which was omitted in 36 patients (59%) because of heavy annular calcification and in 25 (41%) for other reasons including limited annular dilatation. Mitral regurgitation was due to bileaflet prolapse in 28 patients (46%), posterior leaflet prolapse in 22 (36%) and anterior leaflet prolapse in 11 (18%). A double orifice repair was performed in 53 patients (86.8%) and a commissural EE was used in 8 (13.1%).
RESULTS: Hospital mortality was 1.6%. At the postoperative echocardiography MR was absent/mild in 49 patients (80.3%), moderate (2+/4+) in 10 (16.3%) and moderate-to-severe in 2 (3.2%). Clinical and echocardiographic follow-up was 100% complete (mean length 9.2±4.21 years, median 9.7, longest 18.1). Actuarial survival at 12.5 years was 51.3±7.75%. At the last echocardiogram, MR≥3+ was demonstrated in 33 patients (55%). At 12.5 years freedom from re-operation was 57.8±7.21% and freedom from the combined end point of reoperation and MR≥3+ was 39.7±7.81%. The only predictor of the combined end-point of reoperation and MR ≥3+ was the presence of residual MR>1+ at hospital discharge (HR 3.8, 95% CI 1.7-8.2, p=0.001). In patients with residual MR ≤1+ immediately after surgery, freedom from reoperation and MR ≥3+ at 5 and 10 years was 80±6% and 64±7.58%, respectively.
CONCLUSIONS: In patients with degenerative MR, the overall long-term results of the surgical EE technique without annuloplasty are unsatisfactory. However many of the patients included in this series would have been challenging also for conventional repair (heavy annular calcification). Early optimal competence (residual MR ≤1+) was associated with higher freedom from recurrent severe regurgitation. These data emphasize the need for appropriate patient selection for mitraclip therapy in order to minimize residual MR after the procedure. In addition they underline the need for a reliable annuloplasty technique to widen the indications of transcatheter mitral repair and improve long term outcomes.
- © 2013 by American Heart Association, Inc.