Outcomes of Degenerative Mitral Valve Repair Surgery for Anterior, Posterior and Bileaflet Pathology

Abstract Background Degenerative mitral valve disease involving anterior leaflet pathology is considered less favorable regarding durability of surgical repair than isolated posterior leaflet disease. We aimed to compare the outcomes of patients undergoing mitral valve repair for anterior, posterior and bileaflet pathologies, and to investigate predictors for repair failure. Methods Of the 760 consecutive patients with degenerative leaflet disease who underwent mitral valve repair, 485 (64%) had posterior, 223 (29%) had bileaflet and 52 (7%) had anterior leaflet pathology. Mean age was 58±12, 54±14 and 58±17years, respectively (p=0.001). Mean follow-up was 67±47 months. Results There was no in-hospital or 30-day mortality. Freedom from reoperation was 97%, 95% and 92%, and there were 25 (5%), 9 (4%) and 1 (2%) late deaths, in the posterior, bileaflet and anterior groups (NS). Late echocardiography revealed that 94%, 97% and 96% of patients (posterior, bileaflet and anterior groups respectively) were free from moderate-severe or severe mitral regurgitation (p=0.375). Post-operative residual mild mitral regurgitation emerged as the strongest predictor for recurrent mitral regurgitation (grade 3/4) at follow-up (HR 2.36 95%CI 1.3-4.29, p=0.005). Unlike patients with excess mitral tissue, among patients with fibroelastic deficiency or those who underwent significant leaflet resection, the use of larger ring-annuloplasty was associated with recurrent mitral regurgitation (HR 1.31 per ring size increment; p Conclusions Mitral valve repair can be achieved with excellent early and intermediate results across all valve pathologies. Further studies are required to determine the potential long-term impact of the underlying pathology on the rate of recurrent mitral regurgitation.