A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines

Background: Although mitral valve repair is the recommended treatment for severe mitral regurgitation of degenerative etiology, valve replacement remains common, particularly for complex lesions or anterior leaflet involvement. We sought to characterize the feasibility and outcomes of an "all comers" repair strategy applied systematically in all cases of degenerative mitral valve disease, regardless of age, complexity, or leaflet involvement.

Methods: From January 2002 to December 2010, 744 consecutive patients (mean age, 58±13 years [range, 12-90]; mean LVEF, 55%±9%) with degenerative mitral valve regurgitation and prolapse (anterior leaflet: n=42, 6%; posterior leaflet: n=556, 75%; bileaflet: n=146, 19%) underwent mitral valve surgery. Annular, leaflet or chordal calcification was present in 27% of cases.

Results: All patients underwent mitral valve repair and received a concomitant annuloplasty with a median ring size of 32 mm (interquartile range, 30-36). There was 1 early valve replacement (99.9% repair rate) due to atrioventricular groove bleeding and 5 late re-repairs (0.7%) due to disease progression or infective endocarditis. In-hospital mortality and major stroke rates were 0.8% and 0.5%, respectively. Survival rates at 1 and 5 years were 99.2%±0.3% and 97.4%±0.8%, respectively. Seven-year freedom from reoperation was 97.1%±0.6%. The estimate of patients with <3+ mitral regurgitation at 4 and 7 years was 98% and 96%, respectively, and 95% and 91%, respectively, for <2+ mitral regurgitation.

Conclusions: A systematic strategy of mitral valve repair that uses a variety of techniques allows repair of all degenerative valves in a reference center, with good short-term outcomes and mid-term durability. Further study is required to document the long-term efficacy of an "all comers" mitral valve repair strategy in degenerative subgroups with very complex valve morphology.