title: Is commissural closure associated with mitral annuloplasty a durable technique for the treatment of mitral regurgitation? A long-term (≤15 years) clinical and echocardiographic study.
abstract: OBJECTIVE
  Mitral regurgitation (MR) due to commissural prolapse/flail can be corrected by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The long-term results of this type of repair are unknown. Our aim was to assess the clinical and echocardiographic outcomes of this technique up to 15 years after surgery.
  
  
  METHODS
  From 1997 to 2007, 125 patients (age, 56.8 ± 15.7 years; left ventricular ejection fraction, 58.1% ± 7.1%) with MR due to pure commissural prolapse/flail of 1 or both leaflets underwent commissural closure combined with annuloplasty. The etiology of the disease was degenerative in 88.8% and endocarditis in 11.2%. The commissural region involved was posteromedial in 96 patients (76.8%) and anterolateral in 29 (23.2%).
  
  
  RESULTS
  Hospital mortality was 1.6%. At discharge, MR was absent or mild in 120 patients (97.5%) and moderate (2+/4+) in 3 (2.4%). Clinical and echocardiographic follow-up was 98.4% complete (mean length, 7.1 ± 3.0 years; median, 6.7; longest follow-up, 15). At 11 years, the actuarial survival, freedom from cardiac death, and freedom from reoperation was 78.8% ± 6.2%, 95.2% ± 3.3%, and 97.4% ± 1.4%, respectively. At the last echocardiographic examination, MR 3+ or greater was demonstrated in 4 patients (3.3%). Freedom from MR 3+ or greater at 11 years was 96.3% ± 1.7%. No predictors for recurrence of MR 3+ or greater were identified. The mean mitral valve area and gradient was 2.9 ± 0.4 cm(2) and 3.4 ± 1.1 mm Hg, respectively. New York Heart Association class I to II was documented in all cases.
  
  
  CONCLUSIONS
  Commissural closure repair combined with annuloplasty provides excellent clinical and echocardiographic long-term results in patients with MR due to commissural lesions.
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: debonis.michele@hsr.it.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Calabrese
authors.affiliation: Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome