title: Long-term results (≤18 years) of the edge-to-edge mitral valve repair without annuloplasty in degenerative mitral regurgitation: implications for the percutaneous approach.
abstract: BACKGROUND
  To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR).
  
  
  RESULTS
  From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). Survival at 12 years was 51.3±7.75%. At the last echocardiographic examination, MR ≥3+ was demonstrated in 33 patients (55%). At 12 years, freedom from reoperation was 57.8±7.21% and freedom from recurrence of MR ≥3+ was 43±7.6%. Residual MR >1+ at hospital discharge was identified as a risk factor for recurrence of MR ≥3+ (hazard ratio, 3.8; 95% confidence interval, 1.7-8.2; P=0.001). In patients with residual MR ≤1+ immediately after surgery, freedom from MR ≥3+ at 5 and 10 years was 80±6% and 64±7.58%, respectively.
  
  
  CONCLUSIONS
  In degenerative MR, the overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. Early optimal competence (residual MR ≤1+) was associated with higher freedom from recurrent severe regurgitation.
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.). michele.debonis@hsr.it.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Calabrese
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Teodora
authors.initials: T
authors.lastname: Nisi
authors.affiliation: From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: mitral valve insufficiency