The Heart Valve Society

Back to 2017 Program


Long-term Results of Posterior Double-suture Annuloplasty for Severe Mitral Regurgitation: A Single-center, Propensity-matched Analysis.
Andrea Garatti, Alberto Canziani, Andrea Daprati, Ali Abu Farah, Francesco Grimaldi, Simone Simeoni, Sonia Tripepi, Lorenzo Menicanti.
IRCCS Policlinico San Donato, San Donato Milanese, Italy.

OBJECTIVE: Prosthetic ring annuloplasty is considered the gold standard technique in mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is easier, cheaper and may have some physiologic advantages over rings, even if its durability is debated. Aim of the study was to review the early and long-term outcome of posterior double-suture annuloplasty technique.
METHODS: From January 2002 to December 2008, 500 patients underwent primary mitral valve repair either with posterior double-suture annuloplasty [DSA; n=147(29%)] or with flexible posterior annuloplasty band [PAB; n=353(71%)]. Differences in patient characteristics were addressed by propensity-score matching(132 pairs). A composite end-point of mitral valve failure(MVF) was calculated as the incidence of MV regurgitation >2+ or need for MV replacement at follow-up.
RESULTS: The distribution of preoperative variables among matched pairs was, on average, equal. Degenerative valve disease was present in 60%, while functional MR with associated CAD was evident in 40% of the patients without significant differences between the two groups. Isolated annuloplasty(65%vs 54% in PAB and DSA respectively) and leaflet repair techniques(35%vs 46%) were similarly performed in both groups(p=.20). In hospital mortality was comparable between the two study groups(3%vs 5%; p=.48). Pre-discharge echocardiography showed excellent results(93% of patients with 0-1+ MR grade) in both groups without significant differences in MV area(p=.93) and mean gradient(p=.71). At a mean follow-up of 82 years, all-cause mortality(33%vs 24% in PAB and DSA respectively,p=.12), need for MV replacement(3.6%vs 5%,p=.49) and cardiac re-hospitalization rate(16%vs 22%,p=.57) resulted comparable between the two groups. Ten year survival(75%vs 71%,p=.51) as well as freedom from MVF(92%vs 84%,p=.39) were similar between PAB and DSA groups. Freedom from MVF was not significantly different among the study groups according to degenerative(p=.34) or functional(p=.45) etiology.
CONCLUSIONS: Suture annuloplasty demonstrated good early and long-term results compared to a matched cohort of patients treated with posterior flexible band. Given its simplicity and cheapness, the technique could be a viable option for MV surgery in minimally-invasive approach, in endocarditis and in developing countries.


Back to 2017 Program