title: Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: up to 21 years of clinical and echocardiographic results.
abstract: OBJECTIVE
  To assess the very long-term clinical and echocardiographic results of the edge-to-edge repair for mitral regurgitation (MR) due to isolated prolapse or flail of the anterior leaflet.
  
  
  METHODS
  From 1991 to 2004, 139 patients (age, 54±14.4 years; left ventricular ejection fraction 56%±7.8%, New York Heart Association class I-II in 68.9%, atrial fibrillation in 20.1%) with severe degenerative MR due to isolated segmental prolapse or flail of the anterior leaflet were treated with the EE technique combined with annuloplasty. MR had resulted from prolapse or flail of the central scallop of the anterior leaflet (A2) in 105 patients (75.5%) and scallops A1 or A3 in 34 (24.4%).
  
  
  RESULTS
  No hospital deaths occurred. At hospital discharge, MR was absent or mild in 130 patients (93.5%) and moderate (2+/4+) in 9 (6.4%). The clinical and echocardiographic follow-up data were 97.1% complete (mean length, 11.5±3.73 years; median, 11; longest duration, 21.5). At 17 years, the actuarial survival was 72.4%±7.89%, freedom from cardiac death was 90.8%±4.77%, and freedom from reoperation was 89.6%±2.74%. At the last echocardiographic examination, recurrence of MR grade≥3+ was documented in 17 patients (17 of 135, 12.5%). Freedom from MR grade≥3+ at 17 years was 80.2%±5.86%. At multivariate analysis, the predictors of MR recurrence grade≥3+ were residual MR greater than mild at hospital discharge (hazard ratio, 7.4; 95% confidence interval, 2.5-21.2; P=.0001) and the use of posterior pericardial rather than prosthetic ring annuloplasty, which was very close to statistical significance (hazard ratio, 2.8; 95% confidence interval, 0.9-8.7; P=.06).
  
  
  CONCLUSIONS
  In patients with MR due to segmental anterior leaflet prolapse, the very long-term results of the edge-to-edge repair combined with annuloplasty were excellent.
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy. Electronic address: debonis.michele@hsr.it.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401: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 / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left