title: Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty: long-term outcomes.
abstract: OBJECTIVE
  Aim of the study was to evaluate late outcomes of mitral valve repair with and without the use of prosthetic ring annuloplasty and standardized techniques for the treatment of degenerative mitral regurgitation (MR).
  
  
  METHODS
  Three hundred and five patients (mean age 62 ± 12 years) underwent mitral valve repair between January 1992 and February 2010 for degenerative MR. In the last five years, all repair techniques were performed routinely using prosthetic ring annuloplasty, with or without quadrangular or triangular resection of posterior leaflet and/or edge-to-edge technique. Mean follow-up (99% complete) was 78 ± 46 (2-220) months.
  
  
  RESULTS
  Operative mortality was 0.9% (3/305), 15-year actuarial survival 82% ± 4%. At 15 years freedom from cardiac death was 89% ± 3.7%, from reoperation 84% ± 5.8%, from endocarditis 100%. Independent predictors of all-causes mortality were advanced age at operation (P=0.0006) and mitral valve repair without reductive prosthetic annuloplasty (P=0.0019). Death for cardiac causes was significantly higher when reductive annuloplasty was performed without the use of prosthetic ring (P<0.01). Late progression to moderate or severe MR was observed in 23/299 patients (7.7%). Independent predictors of progression to moderate or severe MR was annuloplasty without the use of prosthetic ring (P=0.0053) and postoperative residual mild MR (P=0.0014). Reoperation was required in 13/299 patients (4.4%). At 10 years freedom from moderate or severe MR was 86% ± 6% and 92% ± 4% in patients with postoperative absent or trivial residual MR, respectively, as compared to 38% ± 15% in those with postoperative residual mild MR (P<0.0001), freedom from reoperation 94% ± 4% and 90% ± 14% vs. 56% ± 16% (P<0.0001).
  
  
  CONCLUSIONS
  Prosthetic annuloplasty in association with standardized techniques confers over 10 years survival advantage and better durability.
authors.affiliation: Cardiac Surgery Unit, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy. pa.nardi4@libero.it
authors.forename: P
authors.initials: P
authors.lastname: Nardi
authors.forename: A
authors.initials: A
authors.lastname: Pellegrino
authors.forename: C
authors.initials: C
authors.lastname: Olevano
authors.forename: A
authors.initials: A
authors.lastname: Scafuri
authors.forename: A
authors.initials: A
authors.lastname: Lio
authors.forename: P
authors.initials: P
authors.lastname: Polisca
authors.forename: L
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D000536:Aluminum Hydroxide; D002423:Cause of Death; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000536:Aluminum Hydroxide