title: Outcomes after repair of the anterior mitral leaflet for degenerative disease.
abstract: BACKGROUND
  Repair of anterior mitral disease is challenging. Objectives of this study were to (1) compare patients with anterior versus posterior disease, (2) identify factors predisposing to replacement rather than repair in anterior disease, (3) determine durability of, and survival after, repair, and (4) compare outcomes with those after posterior repair.
  
  
  METHODS
  From January 1985 to January 2006, 3,544 patients underwent primary isolated mitral valve surgery for degenerative disease, including 307 isolated anterior (252 repairs, 82%) and 2,754 isolated posterior (2,650 repairs, 96%) leaflet procedures. Logistic regression analysis was used to identify predictors of valve replacement and to generate propensity scores for risk-adjusted comparisons. Durability was assessed by reoperation and return of mitral regurgitation.
  
  
  RESULTS
  Patients with anterior disease were older and more symptomatic, with more chordal elongation and greater changes in cardiac morphology and function; advanced age was associated with replacement (p < 0.0001). Unadjusted freedom from reoperation was 89% at 10 years, worse than after posterior repair (p < 0.0001). Return of 3+ to 4+ mitral regurgitation was more common in those with anterior than posterior repair (11% versus 4% at 1 year; p = 0.03). Unadjusted survival was 83% versus 88% 10 years after posterior repair, but propensity-adjusted survival was similar (p >or= 0.5).
  
  
  CONCLUSIONS
  Patients with anterior disease have more symptoms and greater changes in cardiac structure and function than do patients with posterior disease. Anterior repair is less durable than posterior, but is associated with comparable, excellent long-term survival. More durable repair techniques, applicable to the broader spectrum of anterior disease, are needed.
authors: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. gillinom@ccf.org
authors: A Marc
authors: AM
authors: Gillinov
authors: Eugene H
authors: EH
authors: Blackstone
authors: Abdulrahman
authors: A
authors: Alaulaqi
authors: Joseph F
authors: JF
authors: Sabik
authors: Tomislav
authors: T
authors: Mihaljevic
authors: Lars G
authors: LG
authors: Svensson
authors: Penny L
authors: PL
authors: Houghtaling
authors: Arash
authors: A
authors: Salemi
authors: Douglas R
authors: DR
authors: Johnston
authors: Bruce W
authors: BW
authors: Lytle
mesh_terms: D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome