Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation

Abstract

Objective: The very long-term results of the double-orifice mitral valve repair are unknown. The aim of this study was to assess the late clinical and echocardiographic outcomes of this technique in patients with degenerative mitral regurgitation.

Methods: From 1993 to 2000, 174 patients with severe degenerative mitral regurgitation were treated with the double-orifice technique combined with ring annuloplasty. Mean age of patients was 52 ± 12.8 years, New York Heart Association class I or II was present in 71% of the patients, atrial fibrillation in 17.2%, and preoperative left ventricular ejection fraction was 59.5% ± 7.5%. Mitral regurgitation was due to anterior leaflet prolapse in 36 patients (20.6%), bileaflet prolapse in 128 (73.5%), and posterior leaflet prolapse in 10 patients (5.7%).

Results: There were no hospital deaths. At hospital discharge, mitral regurgitation was absent or mild in 169 patients (97.1%) and moderate (2+/4+) in 5 patients (2.8%). Mitral stenosis requiring reoperation was detected in 1 patient (0.6%). Clinical and echocardiographic follow-up was 97.1% complete (mean length, 11.5 ± 2.53 years; median, 11.6 years; longest duration, 17.6 years). At 14 years, actuarial survival was 86.9% ± 3.37%, freedom from cardiac death was 95.8% ± 1.54%, and freedom from reoperation was 89.6 ± 2.51%. At the last echocardiographic examination, recurrence of mitral regurgitation ≥3+ was documented in 23 patients (23/169, 13.6%). Freedom from mitral regurgitation ≥3+ at 14 years was 83.8% ± 3.39%. The only predictor of recurrence of mitral regurgitation ≥3+ was residual mitral regurgitation greater than mild at hospital discharge (hazard ratio, 5.7; 95% confidence interval, 1.6-20.6; P = .007).

Conclusions: The double-orifice repair combined with ring annuloplasty provides very satisfactory long-term results in patients with degenerative mitral regurgitation in the setting of bileaflet and anterior leaflet prolapse.