Long-term results of mitral valve repair with semi-rigid posterior band annuloplasty.
OBJECTIVE
Optimal repair of the mitral valve involves the implantation of an annuloplasty device to geometrically reshape and/or stabilize the annulus and improve long-term durability. It has been reported previously that trigone-to-trigone semi-rigid posterior band (PB) annuloplasty is associated with excellent short-term outcomes, physiologic motion of the anterior mitral annulus and leaflet, and lower postoperative transvalvular gradients compared to complete ring (CR) annuloplasty. The aim of this retrospective study was to compare the long-term effectiveness of PB and CR annuloplasty in patients with degenerative mitral valve regurgitation (MR).


METHODS
Between 1993 and 2010, a total of 1,612 patients with degenerative MR underwent mitral valve repair (MVr) with either PB (n = 1,101) or CR (n = 511). Initially, CR was the annuloplasty device of choice, but after 2001 PB was preferred. A retrospective review of clinical and echocardiographic follow up was performed on these patients. The eight-year cumulative freedom from adverse events were determined by life-table analysis.


RESULTS
Hospital mortality was 1.9% overall (n = 30/1612), but 1.3% (12/939) for isolated MVr, and 2.7% (18/673) for MVr with concomitant procedures (p = 0.04). Hospital mortality was similar for both PB (1.9%; 21/1101) and CR (1.8%; 9/511) (p = 0.8). The mean MR grade was reduced from 3.9 +/- 0.3 preoperatively to 0.6 +/- 0.9 at follow up using PB (p < 0.01), and from 3.9 +/- 0.4 to 0.9 +/- 0.9 using CR (p < 0.01). PB was associated with a similar long-term freedom from death (77 +/- 0.03% versus 83 +/- 0.02%; p = 0.4), reoperation (95 +/- 0.01% versus 92 +/- 0.01%; p = 0.06), and reoperation or recurrent severe MR (91 +/- 0.02% versus 92 +/- 0.01%; p = 0.7), and slightly greater freedom from valve-related complications compared to CR (91 +/- 0.02% versus 87 +/- 0.02%; p = 0.02).


CONCLUSIONS
The long-term outcome of mitral valve annuloplasty with PB was comparable to that with CR for degenerative disease. Anterior annuloplasty was found to be unnecessary in this patient population.
David W
DW
Yaffee
Didier F
DF
Loulmet
Elias A
EA
Zias
Patricia A
PA
Ursomanno
Annette E
AE
Rabinovich
Aubrey C
AC
Galloway
Eugene A
EA
Grossi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult