Abstract
IntroductionMitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings. Unsupported valvuloplasty is performed in only a few centers. This study aimed to report long-term outcomes of patients undergoing unsupported valvuloplasty for degenerative mitral regurgitation (MR) and to identify predictive factors for outcomes.MethodsThis is a retrospective cohort including patients undergoing mitral valve repair for degenerative MR from 2000 to 2018. The main techniques were Wooler annuloplasty and quadrangular resection. Kaplan-Meier curves and Cox regression models were used for statistical analysis.ResultsOne hundred fifty-eight patients were included (median age: 64.0 years). In-hospital mortality was 2.5%. Maximum follow-up was 19.6 years, with a median of 4.7 years (992 patient-years). Overall survival at 5, 10, and 15 years was 91.0% (95% confidence interval [CI]: 85.7-96.3), 87.6% (95% CI: 80.7-94.5), and 78.1% (95% CI: 65.9-90.3), respectively. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was an independent predictor of late death (hazard ratio [HR] 1.42; P=0.016). Freedom from mitral reoperation at 5, 10, and 15 years was 88.1% (95% CI: 82.0-94.2), 82.4% (95% CI: 74.6-90.2), and 75.7% (95% CI: 64.1-87.3), respectively. Left atrial diameter > 56 mm was associated with late reintervention in univariate analysis (HR 1.06; P=0.049).ConclusionDegenerative MR can be successfully treated with repair techniques without annular support, thus avoiding the technical and logistical drawbacks of ring/band implantation while maintaining good long-term results. EuroSCORE II was a risk factor for late death, and larger left atrium was associated with late reoperation.
Highlights
Mitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings
EuroSCORE II was a risk factor for late death, and larger left atrium was associated with late reoperation
Without underestimating the preference of most centers dedicated to mitral valvuloplasty for prosthetic ring implantation, which is considered by some to be essential, our experience gained over the years of practice in the specialty, associated with the growing emphasis in recent decades on prioritizing mitral valve repair over replacement, prompted us to review the results of mitral valve repair procedures performed in a center that does not prioritize ring implantation; on the contrary, it does not even use ring implantation as part of the routine valve reconstruction procedures for mitral regurgitation (MR)
Summary
Mitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings. Unsupported valvuloplasty is performed in only a few centers. This study aimed to report long-term outcomes of patients undergoing unsupported valvuloplasty for degenerative mitral regurgitation (MR) and to identify predictive factors for outcomes. Most centers use rigid and flexible rings or posterior annular support bands in order to achieve stability, standardization, reproducibility, and durability of the results in valve repair[4,5]. Ring valvuloplasty has drawbacks and potential risks, such as increased times of cardiopulmonary bypass and myocardial ischemia, as well as increased procedure costs. Posterior bands and semicircular prosthetic rings minimize complications while maintaining the idea of support. Extensively reported in the literature and disseminated at events, none of these techniques is based on clinical evidence, such as randomized clinical trials
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