Ring-Only Mitral Valve Repair of Severe Mitral Regurgitation in Myxomatous Degeneration with Balanced Multi-Segment Bileaflet Prolapse

Background: Repair of severe mitral valve regurgitation (MR) in patients with multi-segment bileaflet prolapse is challenging. We aimed to compare outcomes of ring-only repair (ROR) with more complex repair strategies in severe MR due to Barlow’s disease.

Methods: Ninety-five patients with degenerative multi-segment bileaflet disease (age 54±15 years; 46% male) underwent ROR for severe MR with a predominantly central regurgitant jet indicating balanced bileaflet prolapse. Outcomes were compared with those of 120 patients with bileaflet prolapse who, during the same period (2004-2019), underwent repair that included leaflet-chordal interventions in addition annuloplasty.

Results: Perioperative mortality (0% vs. 0%), stroke rate (0% vs. 0.8%) and late mortality (4.2% vs. 5.8%) in ROR were comparable to control, aortic clamp times were shorter (58±19 vs. 77±33 min, p<0.001). No post-repair outflow tract obstruction (SAM) was observed. At follow-up, there was one (1.1%) reoperation in the ROR group compared with 10 (8.3%) in the control group (p=0.036). Freedom from reoperation or significant MR over 59±48 months was 97.6% for ROR and 84.1% (p=0.021) in the control group (Figure). No ROR (p=0.035) and larger ring size (p=0.016) were the only independent predictors of reoperation or recurrent MR.

Conclusion: In patients with severe MR and a central regurgitant jet due to balanced multi-segment bileaflet mitral valve prolapse ROR is simple and provides excellent long-term results without a significant risk of SAM even with smaller ring size.