How Does Mitral Valve Repair Fail in Patients With Prolapse?-Insights From Longitudinal Echocardiographic Follow-Up

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Heart Valve Repair

Background:

• Mitral regurgitation (MR) repair for prolapse is established, yet failure mechanisms beyond reoperation need clarification.
• Understanding failure modes is crucial for improving long-term outcomes of mitral valve repair.

Purpose of the Study:

• To investigate the specific modes of mitral repair failure in patients with MR caused by prolapse.
• To identify factors associated with mitral valve reoperation after initial repair.

Main Methods:

• A cohort of 855 patients undergoing MR repair for prolapse between 2001-2015 was analyzed.
• Serial clinical and echocardiographic follow-up was conducted for an average of 4.3 years.
• Failure modes and need for reoperation were systematically recorded.

Main Results:

• Freedom from recurrent MR (≥2+) was 92.4% at 5 years and 86.6% at 10 years.
• Recurrent MR (≥2+) developed in 5.7% of patients, with severe MR (3-4+) in 1.6%.
• Early recurrence (within 1 year) was strongly associated with subsequent mitral valve reoperation.

Conclusions:

• Severe MR after mitral repair is rare; moderate recurrence is more common.
• Recurrent MR within the first year post-repair is a key predictor of reoperation.
• Further research into early failure mechanisms can optimize mitral repair strategies.