Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair.
BACKGROUND
Guidelines recommend early surgery for mitral regurgitation (MR) provided repair can be accomplished safely and consistently. However, many patients with degenerative disease are not referred for surgery or undergo replacement rather than repair. Data documenting early and long-term results of surgical repair of posterior prolapse, the most common lesion, are essential to broaden application of repair techniques and provide direction for percutaneous valve repair. This study provides data on long-term survival and valve function after repair of posterior leaflet prolapse.


METHODS
Of 3,383 patients undergoing surgery for isolated posterior leaflet prolapse, repair was performed in 97%; 3,074 underwent standard quadrangular resection with annuloplasty. Follow-up for survival averaged 6.5 +/- 4.5 years and for reoperation, 4.0 +/- 3.9 years. Analysis of 4,913 echocardiograms for recurrent MR was performed in a subgroup of 2,575 patients.


RESULTS
There were two hospital deaths (0.07%), and 15-year survival was 76%, superior to the age- and sex-matched US population. At 10 years, freedom from mitral reoperation was 97%, and 77% had no or 1+ MR; 11% had 3+ or 4+ MR. Repair durability was jeopardized by failure to use a prosthetic annuloplasty, left atrial enlargement, and left ventricular remodeling and dysfunction.


CONCLUSIONS
Mitral valve repair for posterior prolapse is a low-risk, durable surgical procedure. The repair must address both leaflet and annulus. Recurrent MR that is moderately severe or severe is uncommon in the decade after operation. These data support recommendations for early surgery and demonstrate that complete repair addresses multiple components of the valve, providing direction for percutaneous approaches.
Johnston
Douglas R
DR
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Gillinov
A Marc
AM
Blackstone
Eugene H
EH
Griffin
Brian
B
Stewart
William
W
Sabik
Joseph F
JF
Mihaljevic
Tomislav
T
Svensson
Lars G
LG
Houghtaling
Penny L
PL
Lytle
Bruce W
BW
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002815:Chordae Tendineae / Q000601:surgery; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011336:Probability; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome