Abstract 2869: Mitral Valve Repair using Autologous Pericardium Annuloplasty: Eighteen-Years Experience in 490 Patients

Autologous Pericardium Annuloplasty (APA) is an alternative option to prosthetic ring, avoiding foreign material implantation and preserving the physiological motion of mitral annulus but contrasting data on durability are reported. We sought to evaluate the very long term results of mitral valve repair (MVR), for mitral regurgitation (MR), with posterior annuloplasty performed with glutaraldehyde-treated autologous pericardium. Between July 1988 and Dec 2006, 490 consecutive patients underwent MVR with posterior APA, in addition to other repair procedures. Mean age was 54.3±11.3 (range 15–77y) and 360 (74.1%) men. Valve disease was purely degenerative in 434 (89.3%) patients, endocarditis was present in 44 (9.1%). Anterior, posterior and bileaflet leaflet prolapse were present in 32 (6.6%), 241 (49.6%) and 213 (43.8%) respectively. Gore-Tex® neo-chordae were implanted in all patients. Posterior leaflet quadrangular resection was performed in 283 patients (58.2%). Echocardiographic Doppler studies were obtained annually and clinical follow-up was 100% complete at a mean of 7.1±4.4 years (range 1–18y). In-hospital mortality was 1% (5 deaths), overall and cardiac late mortality 7.6% and 3.9% (37 and 19 deaths). Kaplan-Meier curves for mortality and freedom from reoperation at 15 years were 83% (95% CI 71–90) and 93% (95% CI 88–96) (20 patients). At 15 years freedom from recurrent MR and endocarditis were 86% (95% CI 77–91) (28 patients) and 97% (95% CI 92–99) (6 events), respectively. Dehiscence or calcification of APA were never reported. At reoperation, annular pericardium appeared covered by a smooth layer of tissue, without signs of degeneration. None of the patients experienced hemolysis. MVR with posterior autologous pericardial annuloplasty is feasible, safe and cost effective, providing long-term durability. APA is intended to preserve the anatomical and physiological characteristics of the mitral annulus, avoiding prosthetic material, especially in young patients or endocarditis etiology. In contrast to data presented in literature, in our series, APA showed a high survival and low rates of valve-related complications at very long-term follow-up, with a high freedom from recurrent MR.