Simple versus complex degenerative mitral valve disease.

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Heart Valve Repair

Background:

• Degenerative mitral valve (MV) disease is a common condition requiring surgical intervention.
• Mitral valve repair is favored over replacement for most patients with degenerative MV disease.
• The complexity of MV prolapse (simple posterior vs. complex anterior/bileaflet) may impact repair outcomes.

Purpose of the Study:

• To compare the outcomes of mitral valve repair for simple versus complex degenerative MV disease.
• To assess the durability and long-term results of MV repair in different patient groups.

Main Methods:

• Retrospective analysis of 6153 patients undergoing primary isolated MV repair for degenerative disease from 1985-2016.
• Patients were categorized into simple (posterior prolapse) and complex (anterior or bileaflet prolapse) groups based on echocardiography.
• Propensity score matching (n=2065 pairs) was used for risk-adjusted comparisons of recurrence, reoperation, and survival.

Main Results:

• Patients with complex MV disease were younger and more likely female, with similar symptoms compared to simple disease patients.
• Ring/band annuloplasty and leaflet resection were common repair techniques in both groups.
• At 10 years, severe mitral regurgitation recurrence was 6.2% for simple vs. 11% for complex disease (P=.007).
• At 18 years, reoperation rates were 6.3% for simple vs. 11% for complex disease.
• 20-year survival was similar: 62% for simple vs. 61% for complex disease (P=.6).

Conclusions:

• Mitral valve repair offers low operative risk and comparable long-term survival for both simple and complex degenerative MV disease.
• Repair durability is reduced in complex MV disease, indicated by higher rates of mitral regurgitation recurrence and reoperation.
• Lifelong annual echocardiographic surveillance is recommended post-MV repair, especially for patients with complex valve pathology.