The Heart Valve Society

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100 % Success Rate of Mitral Valve Repair is not Related to the Complexity of the Lesion
Gilles D. Dreyfus1, Filip Dulguerov1, Cecilia Marcacci1, Clara Alexandrescu1, Franck Levy1, Shelley Rahman Haley2, Elie D. Schouver1.
1Cardio Thoracic Center of Monaco, Monaco, Monaco, 2Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

OBJECTIVE: Mitral Valve Repair (MVR) is the Gold Standard to treat severe Mitral Regurgitation (MR) in degenerative disease. However, in the real world, mitral valve replacement is still often preferred in case of complex lesions such as anterior leaflet prolapse, posterior commissural prolapse or extensive annular calcification. The aim of the study is to report the outcome of patients who underwent MVR for degenerative disease without any selection bias (intention to treat of 100% equals the rate of MVR). METHODS: From January 2005 until December 2015, 701 patients with severe MR from all etiologies underwent MVR by a single surgeon. There were 441 degenerative MR among which 376 patients with posterior leaflet prolapse, including 93 isolated P2 and 283 associated to other segments (P1, P3, posterior commissure, anterior leaflet), and 65 patients with anterior isolated prolapse. Extensive annular calcification was present in 77 patients (17.5%). Patients mean age was 67+/- 13,1 years, there were 311 males (70,5%) and 280 patients were in NYHA class 1 or 2 (63,6%). All patients were operated using a variety of surgical techniques specifically tailored to mitral valve lesions identified during the intraoperative analysis.RESULTS: There were 3 hospital deaths (0,7 %). There was no systolic anterior motion. Follow up was complete for 430 patients (97,4%) with a mean duration of 4,4 +/- 3,2 years. All patients were followed annually and echocardiograms were performed in our core lab. Mean coaptation height was 8 +/- 2,07 mm. 393 patients showed 0 or 1+ MR (89,1 %), 36 showed 2+ (8,2 %) and 12 showed 3+ or more ( 2,7 %) among which 5 were re-operated (1,1 %). Freedom from reoperation at 10 years was 98,6%. Survival at 10 years was 87,3%.CONCLUSION: Our a 100 % repair rate policy, based on specifically designed for each lesion surgical techniques, shows a low operative mortality and a very low incidence of residual/recurrent MR and reoperation at long term, even in the subgroup of patients with very complex valve morphology. Lesion complexity should not be a criterion to prefer mitral valve replacement to MVR, especially for young or asymptomatic patients.


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