Valve Repair For Mitral Regurgitation Research Articles

Detection of Left Ventricular Dysfunction Using Early Diastolic Mitral Annular Velocity in Patients Undergoing Mitral Valve Repair for Mitral Regurgitation

Ejection fraction (EF) is considered an unreliable index in patients with mitral regurgitation (MR). Left ventricular dysfunction (LVD) frequently occurs after mitral valve repair (MVR), with the incidence being 15% to 34%. This study aimed at investigating whether preoperative early diastolic mitral annular velocity (E') is associated with LVD after MVR. Retrospective study. University hospital. Sixty-three patients undergoing MVR for severe MR. None. LVD was defined by a postoperative EF of<50%. Receiver operating characteristic (ROC) analysis and separate multivariate logistic regression models were used to examine the independent effects of echocardiographic variables on LVD risk. LVD occurred in 20 patients (31.7%). E' was correlated significantly with perioperative EF change (p = 0.019, r = 0.293). The area under the ROC curve was 0.777 (95% confidence interval [CI]: 0.644-0.911) for E', and the optimal threshold value of E' for predicting LVD was 6.5 cm/s (sensitivity, 80%; specificity, 67.4%). The frequency of LVD was 33.3% for a preoperative EF< 65%; 44.4% for preoperative EF< 65% and left ventricular end-systolic diameter>32 mm; and 88.9% for preoperative EF< 65%, left ventricular end-systolic diameter>32 mm, and E'< 6.5 cm/s (p = 0.006). Multivariate logistic regression models analysis revealed that E' was an independent risk factor for LVD (odds ratio: 1.98, 95% CI: 1.22-3.22). Preoperative E' value was an independent risk factor of LVD after mitral valve repair in patients with severe MR.

Percutaneous mitral repair with-mitraclip system, safety and efficacy; initial Egyptian experience

To evaluate the feasibility, efficacy, and safety of the MitraClip system in patients with severe MR. Mitral valve repair for mitral regurgitation (MR) has been performed by the use of a surgically created double orifice. Percutaneous repair based on this surgical approach has been developed by use of the MitraClip device to secure the mitral leaflets. Five Patients with 3 to 4+ MR were selected in accordance with the American Heart Association/American College of Cardiology guidelines between March 2013 and May 2013 and underwent percutaneous mitral repair with MitraClip system . Patients were followed up for six months after procedure. The primary acute safety endpoint was freedom from major adverse events (MAEs) at 30 days, defined as the composite of death, myocardial infarction, non-elective cardiac surgery for adverse events, renal failure, transfusion of more than 2 units of blood, ventilation for more than 48 h, deep wound infection, septicemia. The primary efficacy endpoint is acute device success defined as clip implant with reduction of MR to equal or less than grade II, based on current guidelines. A total of 5 patients were treated. No patients (0%) had a major adverse event,. Freedom from clip embolization was 100%. Partial clip detachment had not occurred in any patients (0%) patients. Overall, 4 of 5 (80%) patients achieved acute procedural success, and 3 (60%) were discharged with MR of ⩽ 1+. Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to edge mitral valve repair is feasible and may be accomplished with favorable short-term safety and efficacy results.

Early Outcome of Mitral Valve Repair for Mitral Regurgitation

PP-400 Mitral valve repair is considered to be the ideal treatment for both ischemic and degenerative diseases. All 58 patients who had mitral valve repair for mitral regurgitation from 2010 to 2012 were prospectively followed for up to 24 months (mean 16.3±6.4, range 6-24). Mean age was 62.46±

Using Imaging to Guide Patient Selection and Performance of Catheter-Based Mitral Valve Repair for Mitral Regurgitation

Percutaneous transcatheter therapies for mitral regurgitation have found a role for patients at high operative risk with both degenerative and functional pathologies. The MitraClip therapy utilizes a catheter-based system to deliver a clip-type implant to provide apposition between anterior and posterior mitral leaflets. Key to the procedure is using imaging to guide patient selection as well as intra-procedure performance. Careful patient selection remains paramount for success with the MitraClip, with imaging determination of appropriate mitral pathology. Technical success is dependent on skill with echocardiographic imaging, with three-dimensional transesophageal echocardiography particularly valuable.

Mitral commissurotomy through the left ventricle apical orifice with Heart Ware left ventricular assist device implantation

Diseased, replaced or repaired mitral valve can lead to restricted blood flow to left ventricle and inadequate flow in left ventricular assist device (LVAD). A middle age woman with ‘burnt out’ hypertrophic cardiomyopathy had mitral valve repair for mitral regurgitation. She needed LVAD to support severe decompensating heart failure. Repaired mitral valve posed a risk of restricted flow through the device. Mitral commissurotomy was performed on beating heart through the left ventricular apical hole created for insertion of inflow cannula of LVAD.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Late Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease

The pathological spectrum of degenerative diseases of the mitral valve (MV) that causes mitral regurgitation (MR) is broad, and there is limited information on late outcomes of MV repair in various subgroups of patients and pathologies. This study examines this issue. All 840 patients who had MV repair for MR due to degenerative diseases from 1985 to 2004 were prospectively followed with clinical and echocardiographic evaluations at biennial intervals up to 26 years, median of 10.4 years. Clinical, hemodynamic, and pathological variables were evaluated for their association with outcomes. Age, left ventricular ejection fraction, and functional class were predictors of late cardiac- and valve-related deaths by multivariable analysis. MV repair failed to restore life span to normal in patients with functional class IV. Thirty-eight patients had repeat MV surgery, and the probability of reoperation at 20 years was 5.9%. During the follow-up, recurrent severe MR developed in 37 patients, and moderate MR developed in 61. Age, isolated prolapse of the anterior leaflet, the degree of myxomatous changes in the MV, lack of mitral annuloplasty, and duration of cardiopulmonary bypass were associated with increased risk of recurrent MR. At 20 years, the freedom from recurrent severe MR was 90.7%, and the freedom from moderate or severe MR was 69.2%. MV repair for degenerative MR restored life span to normal except in patients with symptoms at rest and impaired left ventricular function. Advanced age and complex mitral valve pathologies increased the risk of late recurrent MR.

555 Mitral Regurgitation Lesion Type Impacts Outcomes Following Mitral Valve Repair in Patients With Non-Ischemic Cardiomyopathy and Severe Left Ventricle Dysfunction

mmHg for band patients and 5.8 / 2.6 mmHg for ring (P .0001). Mean mitral valve area at rest was 2.3 / 0.6 cm for band and 1.8 / 0.5 cm for ring (P .0001). Exercise duration was 12.9 / 5.7 min for band and 12.6 / 5.7 min for ring (P .78); distance covered was respectively 471 / 77 m for band and 443 / 107 m for ring (P .12). At peak exercise, mean mitral gradient was 10.6 / 4.8 mmHg for band vs 15.3 / 8.2 mmHg for ring (P .0002) while RVSP was respectively 45.8 / 9.5 mmHg for band and 52.6 / 14.2 mmHg for ring (P .004). FMS was present in 17% of band patients vs 55% of ring patients (P .0001). Congestive heart failure (P .05) and atrial fibrillation (P .006) were associated with the utilization of a ring annuloplasty; in addition, ring patients reported lower levels of energy (P .02) and general health (P .007) on their SF-36. Predictors of FMS included ring usage (OR 3.8, 1.3-11.8), smaller resting mitral valve area (OR 9.2, 2.5-33.3) and younger patients (OR 6.9, 2.3-21.5). CONCLUSION: In this first study using full echocardiographic and functional assessment of patients with degenerative mitral valve disease following mitral valve repair, the utilization of a mitral ring was associated with functional mitral stenosis, recurrence of CHF and markers of poorer quality of life. In light of these findings, we have adjusted our techniques and would recommend that careful consideration be given to the selection of an annuloplasty device at the time of mitral valve repair.

Percutaneous vs Surgical Repair of Mitral Valve Regurgitation: Single Institution Early and Midterm Outcomes

BackgroundThe objective of this study was to compare outcomes of surgical repair (SR) vs MitraClip (MC) implantation for severe mitral regurgitation (MR). MethodsA retrospective analysis of patients treated within a single institution was performed. Patients had EuroSCORE [European System for Cardiac Operative Risk Evaluation] < 20%, left ventricular ejection fraction ≥45%, and grade 3+/4+ MR. ResultsFifty patients (24 [48%] MC group, 26 [52%] SR group) with EuroSCORE 7.9 ± 5.6 were included. The MC group included 24 (48%) and the SR group 26 (52%) patients. Patients in the MC group had a significantly more complex comorbid profile (P < 0.001). Successful MC placement was in 22 patients (91.7%) and SR in 26 (100%). At discharge, no patient had grade 3+/4+ MR. There were no in hospital or 30-day deaths. At follow-up (mean 526 ± 398 days), further mitral valve surgery was necessary in 1 (3.8%) patient in the SR group and in 2 (8.3%) patients in the MC group (P = 0.26). One-year freedom from composite end point (death, stroke, myocardial infarction, major bleeding, cardiac rehospitalization) was 75.5% (SR 83% vs MC 67%; P = 0.18). Degree of residual MR Degree of residual MR immediately after the procedure was equally distributed in both groups (P = 0.13) and the sole independent determinant for composite outcome (odds ratio, 16.9; P = 0.024). ConclusionsMC in nonsurgical candidates and SR in surgical patients showed similar perioperative and follow-up outcomes at an institution experienced with both techniques. Neither MC nor SR were independently related to outcome whenever similar degrees of acute correction with minimal residual MR were achieved. However, these findings should be interpreted within the selection biases and the numerical limitations of the present study.

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肥大型心筋症を伴う僧帽弁閉鎖不全症に対する僧帽弁形成術後, 左室流出路狭窄・溶血をきたした1例

Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery: Case Series and Review of Literature

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart lesion that if left untreated, results in high mortality. Surgical treatment options include reimplantation of the anomalous coronary ostia, use of extracardiac arterial blood supply, or the Takeuchi procedure. The Takeuchi procedure involves creation of an aortopulmonary window and an intrapulmonary tunnel that baffles the aorta to the ostium of the anomalous left coronary artery. The incidence of late complications following the Takeuchi repair is unknown. The goal of our study was to determine the long-term outcome after palliation of ALCAPA using the Takeuchi Procedure. A total of 9 patients with a history of ALCAPA palliated with the Takeuchi procedure were identified from our surgical database. Chart review was performed. The mean age at time of Takeuchi procedure was 49.6 months (range 5 weeks-14.6 years). There was one late death, of unknown cause. Of the remaining 8 patients, the mean length of follow-up after surgery was 15.9 years (13.5-19.7 years). All 8 survivors had some degree of main pulmonary artery stenosis in the area of the intrapulmonary baffle, with moderate stenosis in 2 and severe stenosis in 1. Three late survivors (38 %) had a baffle leak. Two patients (25 %) had decreased left ventricular systolic function and 3 (38 %) had developed at least moderate mitral valve regurgitation. Three of the 8 late survivors (38 %) required a reoperation for repair of mitral valve regurgitation, baffle leak, and main pulmonary artery (MPA) stenosis. Review of literature demonstrated similar complication rates and need for reoperation following the Takeuchi procedure. Compared with patients after direct reimplantation for ALCAPA at our institution, there was no significant difference in late survival or freedom from reoperation. The Takeuchi procedure is a method to establish a two-coronary repair for ALCAPA. Late complications are common, necessitating lifelong care in a center experienced with caring for adults with congenital heart disease.

Mitral valve surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Mitral valve surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Improvement of Mitral Valve Coaptation with Supraannular Plication of the Posterior Annulus —A Newly Designed Strip for Posterior Annular Plication—

The aim of this study was to evaluate a newly-designed mitral annuloplasty strip (the Mitra-Lift(®) strip) in patients undergoing mitral valve repair for mitral regurgitation (MR). A total of 30 patients who underwent posterior mitral strip annuloplasty for moderately severe to severe MR were evaluated in this study. The strip annuloplasty (SA) consisted of the use of the newly-designed strip and the suture of the supra-annular atrial wall of 5.0 mm width and the posterior annulus. In addition to SA, six patients (20.0%) with tethered posterior leaflets required posterior leaflet augmentation. Improvement in MR and hemodynamic parameters of the valve with the fixed strip were assessed. After SA, all patients exhibited little or no MR, with no individual exhibiting signs of exacerbation during the follow-up period. A stable coaptation occurred below the strip and the posterior annulus due to forward movement and lifting of the posterior annulus without significant reduction of intercommissural dimension. During the cardiac cycle, the intercommissural dimensions showed considerable changes, which meant a dynamic motion of the anterior leaflet and the commissures. Formation of a stable leaflet coaptation was associated with a dynamic change of the intercommissural dimension during the cardiac cycle and resulted in a reliable, annuloplasty strip, representing a new concept in annuloplasty.

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Mitral valve repair has become the procedure of choice for almost every type of mitral regurgitation (MR) in the current surgical era. We assessed clinical outcomes of mitral valve repair in severe MR. In this prospective cohort study, 103 patients (61 male, 42 female, mean age 53.2±14.8 years), who were planned to undergo valve repair were included. Mitral valve pathology was regurgitant in 86% and mixed in 14% of patients. The intention to perform mitral repair was successful in 100 (97.1%) of patients. Concomitant procedures were performed in 57 (57%) patients including 31 coronary artery bypass grafting and 13 tricuspid valve repairs. After surgery, early (<30 days) and late (>30 days) complications were recorded. Postoperative echocardiography was performed in all patients at discharge and during clinical follow-up. Late survival and freedom from adverse events including thromboembolism, endocarditis, reoperation, and residual severe MR were estimated by using the Kaplan-Meier survival analysis. There was no early mortality. Echocardiographic assessment of patients at discharge revealed no/trivial regurgitation in 89% and mild (1+) MR in 11% of all patients. Late mortality occurred in only one patient at 14 months because of renal failure. The mean follow-up period of patients was 21.2±10.3 months. Echocardiographic examination during follow-up revealed that mitral insufficiency was none or mild in 96% of patients. Three (3%) patients had moderate (2+) MR and were treated medically. Mitral insufficiency recurrence with severe (3+) regurgitation occurred in one (1%) patient undergoing coronary artery revascularization and concomitant left ventricular aneurysmectomy. Re-operation was needed in only one (1%) case because of infective endocarditis that was treated with mechanical valve replacement. Kaplan-Meier estimates were 99±2.7% for late survival and 98±2.2%, 99±2.7%, 99±2.7% and 99±0.9% for freedom from thromboembolism, endocarditis, reoperation, and residual severe MR, respectively. This study showed that mitral valve repair provides excellent surgical outcomes. Repair procedures are safe, and highly effective, but operations require a considerable surgical experience.

Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction

Left ventricular (LV) dysfunction is the first cause of late mortality after mitral valve surgery. In this retrospective analysis, we studied the association between preoperative echocardiographic LV measures and occurrence of LV dysfunction after mitral valve repair (MVR). Between 1991 and 2009, 335 consecutive patients underwent MVR for severe mitral regurgitation due to leaflet prolapse in our institution. Echocardiography was performed preoperatively and at 10.8 (9.1-12.0) months after surgery in 303 patients who represented the study population. Cardiac events were recorded during follow-up. LV ejection fraction (EF) decreased from 68 ± 9% before surgery to 59 ± 9% post-operatively (P < 0.001). Preoperative EF <64% and LV end-systolic diameter (ESD) ≥ 37 mm were the best cut-off values for the prediction of post-operative LV dysfunction (EF < 50%). On the basis of a combined analysis, the occurrence of post-operative LV dysfunction was 9% when EF was ≥ 64% and LVESD < 37 mm, 21% with EF < 64% or LVESD ≥ 37 mm, and 33% with EF < 64% and LVESD ≥ 37 mm (P for trend < 0.001). The combined variable EF < 64% and LVESD ≥ 37 mm added incremental prognostic value to the multivariable regression model (P = 0.001). Simple preoperative echocardiography measures allow the prediction of LV dysfunction after MVR in patients with leaflet prolapse. Patients with preoperative EF ≥ 64% and LVESD < 37 mm incur relatively low risk of post-operative LV dysfunction.

Mechanisms of Recurrent Regurgitation After Valve Repair for Prolapsed Mitral Valve Disease

We assessed mitral valve (MV) function using serial echocardiography as an indicator of the durability of MV repair. The aim of this study was to analyze the mechanisms of recurrent regurgitation after MV repair for degenerative disease. From 1991 to 2007, 736 patients had valve repair for mitral regurgitation caused by leaflet prolapse: 346 patients had posterior and 390 had anterior leaflet prolapse. The mean age was 54.6±14.6 years, with 495 males. The durability and mechanisms of recurrent regurgitation were evaluated by the findings of echocardiography and reoperation. Follow-up and late echocardiography averaged 5.7±3.9 and 5.1±3.6 years, respectively. Survival was 91.9%±1.5% at 10 years. Freedom from reoperation and moderate or severe regurgitation at 10 years were 91.2%±1.7% and 84.5%±2.1%, respectively. Reoperations were performed for recurrent regurgitation in 29 patients, hemolysis in 5, and endocarditis in 1. Based on the findings of reoperation, the mechanisms of repair failure were procedure related in 9 (25.7%), valve related in 25 (71.4%), and unknown in 1. Late echocardiography revealed none to trivial regurgitation in 511 patients, mild in 153, moderate in 26, and severe in 40. Anterior leaflet prolapse, preoperative atrial fibrillation, and no use of annuloplasty ring were independent predictors of recurrent regurgitation. The main causes of moderate or severe regurgitation were leaflet thickening in 34 patients, leaflet prolapse in 20, dehiscence in 10, and unknown in 2. The main mechanism of recurrent regurgitation after MV repair is progressive degeneration that is characterized by leaflet thickening and prolapse, especially in patients with anterior leaflet prolapse.

Systematic evaluation of the flexible and rigid annuloplasty ring after mitral valve repair for mitral regurgitation

Mitral annulus reconstruction is now a common surgical procedure for the treatment of mitral regurgitation. However, there are still controversies in the selection of materials for annuloplasty in the clinical controlled studies available. The purpose of the present systematic review of the literature is to address whether a flexible ring is superior to a rigid ring in terms of improvement in clinical and echocardiographic outcomes. A systematic literature search was undertaken of all clinical control trials comparing the outcomes of mitral annuloplasty surgery with the flexible and rigid ring in MEDLINE, EMBASE, and the Cochrane Library. Overall, 12 published trials were identified as being eligible for overview and were included in the meta-analysis study between 1966 and 2010: four prospective randomized and eight case-control studies. Combined hazard ratios suggested that the flexible annuloplasty ring had no favorable impact on survival: the mean (95% confidence interval (CI)) was 1.24 (0.24-2.24). From the mortality data at maximum follow-up ranging 35-61 months, there was no significant difference on mortality, reoperation, and significant recurrent mitral regurgitation between the two rings. Also, we were not able to find an improvement by flexible rings on shortening fraction, left ventricular end-diastolic volume, end-systolic volume, and end-diastolic and end-systolic diameter. There was a significantly higher ejection fraction in arms for flexible rings relative to rigid rings with pooled standardized mean deviation (SMD) 0.29, 95% CI: 0.06-0.52, p=0.015. Finally, compared to the rigid annuloplasty ring, patients implanted with flexible ones presented significantly a far better effect preserving the mitral valve area: SMD 0.54, 95% CI: 0.13-0.95, p=0.01, and less constrictive for blood flow across the mitral valve, with the pooled SMD of peak velocity (flexible vs rigid: -0.63, 95% CI: -1.12 to -0.13, p=0.013). Except for the improvement in ejection fraction and preserving the mitral valve area effects in the flexible cases, it remains comparable with regard to overall survival, mortality, reoperation, regurgitant recurrence, and left ventricular performance between the flexible and rigid ring.

Surgical approach to end-stage heart failure

End-stage heart failure is a challenging disease with growing incidence. With decreasing heart transplant rates worldwide organ preserving therapies become, again, of interest. The purpose of the present review is to examine the potential challenges of surgical therapies in patients with end-stage heart failure. The gold-standard for end-stage heart failure is and will be cardiac transplantation. However, due to organ shortage this therapy is limited to a few patients. Therefore implantation of ventricular assist devices (VADs) or long-term minimal-invasive partial support devices will increase. Improvements in device design with smaller devices, easier implantation techniques, and modified anticoagulation outcome and long-term success will likely improve. In addition, good quality of life as destination therapy is almost available. Organ conservation surgery (coronary artery bypass grafting and surgical ventricular restoration or surgical repair of mitral valve regurgitation) in end-stage heart failure patients could not prove the expected results. Transcatheter or minimal-invasive approaches of these therapies might become routine in the near future. Due to the overwhelming outcome rates, cardiac transplantation is the most established surgical therapy for end-stage heart failure. VAD therapy is increasing and minimized VADs might further open the market for destination therapy/permanent support.

New sutureless ‘atrial- mitral-valve prosthesis’ for minimally invasive mitral valve therapy

Incompetence is the most relevant dysfunction of the mitral valve. Surgical replacement and reconstruction is the treatment of choice whereas trans-catheter replacement or repair of mitral valve regurgitation proved demanding. We aimed for a new sutureless approach to anchor a biological heart valve in the mitral position without major surgery by inserting a valve-carrying hollow body into the left atrium. A mould representing the porcine left atrium from the pulmonary veins as far as the mitral valve was created. A superelastic Nitinol-skeleton was sutured onto a warp knitted tubular bifurcation of polyvinylidene fluoride (PVDF) multifilaments fitting the mould. This new self-expandable composite-material hollow body customized to the porcine anatomy was equipped with a commercially available biological heart valve. The functionality of this prosthesis was investigated in a circulatory mock loop simulator and the overall properties were examined in an open animal operation. The left atrium was incised and the prosthesis was placed in eight female pigs of 70 kg, under extracorporeal circulation. Prior to implantation, an artificial valve incompetence was created. Hemodynamic, echocardiographic, and radiological examinations were performed. A post mortem examination of the entire heart was performed. In the simulator we could demonstrate that the composite-material hollow body exhibited enough self-expansion to anchor onto the surrounding structures and that the function of the expanded valve was not compromised. In the animal, the prostheses walls almost completely adapted to surrounding structures leading to an exclusion of the left atrium. Sufficient treatment of mitral regurgitation was displayed hemodynamically and by echocardiography, although overall visualization was difficult. Therefore, in the last four animals a CT scan was performed demonstrating full expansion. Autopsy revealed an excellent anchorage of the prostheses. The relevant intracavitary injury and thrombotic formation were not seen. By the use of a composite-material self-expanding hollow body it is possible exclude a complete heart chamber and thereby to anchor a biological heart valve without sutures.

Clinical outcome and factors affecting surgical decision for repair versus replacement in patients with mitral regurgitation

We aimed to identify characteristics differentiating patients undergoing mitral valve replacement versus valve repair for mitral regurgitation (MR) and to investigate retrospectively mid-term clinical and functional outcomes. From January, 2004 to January, 2009 146 patients underwent mitral valve surgery (62 male / 84 female; age: 55.9+/-13.6 [18-80] years) by one surgical team. Mitral valve replacement was performed in 101 patients (69.2 %) and valve repair was performed in 45 patients (30.8%). Mean follow-up time was 586+/-413 days. Life tables were constructed for the analysis of 5-year complication free survival and comparisons were performed between the groups using Log-rank test within 95%CI. The choice of surgical technique depended on the etiology of MR. Degenerative (p=0.001) and ischemic (p=0.014) MR were more common in patients undergoing repair whereas patients with complex rheumatic mitral valve disease (p=0.001) with subvalvular involvement commonly underwent replacement. Overall 30-day mortality was 3.2% (replacement, 3.96%vs repair, 2.22%, p=0.59). Although there was no significant difference between the groups regarding baseline left ventricular ejection fraction (EF) (ischemic p=0.61; non-ischemic p=0.34), improvement was more pronounced in the repair group for both etiologies (ischemic MR, p=0.001; non- ischemic MR p=0.002). Survival at 5-years was 91.7+/-4.7% after repair and 83.5+/-9.2% after replacement, respectively (p=0.83). Freedom from grade 2 or more mitral regurgitation, reoperation, endocarditis, and thromboembolism were 95+/-5% vs 97+/-3% (p=0.71); 95+/-4% vs 98+/-2% (p=0.98); 94+/-4% vs 100% (p=0.16); and 85+/-8% vs 100% (p=0.095) in replacement and repair groups, respectively. This study demonstrates that mitral valve repair is associated with an acceptable operative mortality, satisfactory mid-term survival and better preservation of left ventricular function. Significant differences in favor of repair are expected in long-term follow-up particularly regarding freedom from thromboembolism and endocarditis.