Late Outcomes After Mitral Valve Annuloplasty With a Standard 63-mm Posterior Band

Annuloplasty sizing in mitral valve repair is highly variable and operator dependent, which may compromise long-term durability. At our institution, a standardized 63-mm posterior flexible band has been used for more than 2 decades to simplify repair and improve consistency.

To obtain complete data on long-term outcomes, we studied 186 Olmsted County patients with mitral valve degenerative disease who underwent isolated mitral valve repair with a standard 63-mm band from 1993 to 2022. Clinical data were obtained from the electronic record, and long-term follow-up, including echocardiography, was achieved through the Rochester Epidemiology Project.

Median age was 63 years, and 70% were men. Repair strategy included posterior leaflet repair in 71%, anterior leaflet repair in 19%, and isolated annuloplasty in 10%. Median bypass and cross-clamp times were 51 and 38 minutes, respectively. There were no operative or in-hospital deaths. Median follow-up was 10.5 years. Survival was 94% at 5 years and 84% at 10 years. Echocardiography showed recurrent moderate-to-severe or severe mitral regurgitation in 18 patients, with a cumulative incidence of 4.1% at 5 years and 5.9% at 10 years. Reoperation occurred in 11 patients, with cumulative incidence of 2% at 5 years, 4% at 10 years, and 8% at 15 years. Only 1 patient required reoperation for band dehiscence.

Standardized posterior annuloplasty with a 63-mm band provides durable valve function, low rates of recurrent mitral regurgitation and reoperation, and excellent long-term survival. This simple, reproducible approach avoids complexities of annular sizing and offers outcomes comparable to those reported with traditional sizing methods.