title: Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era.
abstract: BACKGROUND
  Factors predicting long-term survival and reoperative risk after mitral valve repair for subsets with prolapse involving the anterior leaflet in the current era are unclear.
  
  
  METHODS
  Between January 1, 1980 and December 31, 1999, surgical correction of mitral regurgitation was performed in 2,219 patients. We analyzed a subset of 1,411 patients with isolated mitral regurgitation due to leaflet prolapse undergoing mitral repair or replacement (+/- coronary bypass).
  
  
  RESULTS
  Mean age was 64 years, and 1,003 (71%) were men. Mitral repair was performed in 1,173 (83%) patients. Factors independently predicting overall long-term survival included valve repair, younger age, better functional class, and the absence of significant coronary artery disease. After adjusting for these, smaller preoperative left ventricular end-systolic dimension and greater preoperative ejection fraction were associated with superior survival. Mitral reoperation occurred in 97 patients (75 repairs, 22 replacements), at a mean of 4.8 years after initial procedure. Cumulative risk of reoperation was similar for patients having valve repair or replacement. Factors predictive of need for reoperation after initial repair were younger age, anterior leaflet prolapse, chordal shortening, no leaflet resection, no prosthetic annuloplasty, greater than mild residual mitral regurgitation, and coronary artery disease. After valve replacement, the sole determinant of reoperation was use of a biological prosthesis. The durability of repair for prolapse of the anterior leaflet improved significantly during the second decade of the study.
  
  
  CONCLUSIONS
  Mitral repair affords superior long-term survival, with permanence comparable with mechanical valve replacement. In all categories of mitral leaflet prolapse, durability of valve repair has improved over the past decade.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. suri.rakesh@mayo.edu
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
mesh_terms: D000367:Age Factors; D000368:Aged; D001705:Bioprosthesis / Q000706:statistics & numerical data; D002815:Chordae Tendineae / Q000601:surgery / Q000648:ultrastructure; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery* / Q000648:ultrastructure; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000145:classification / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome