Mitral Surgery for Degenerative Anterior Leaflet Disiease

OBJECTIVE:

Mitral valve repair is considered to be the surgical best choice in the presentation of a degenerative mitral valve. However, a degenerative anterior leaflet is surgically more challenging to repair than the degenerative posterior leaflet. Our aim was to compare long term results of repair versus replacement of the mitral valve, in the presence of degenerative anterior leaflet disease.

METHODS:

From 2004 to February 2021, 176 patients with mitral valve degenerative anterior leaflet underwent mitral valve surgery in our department. 77 patients underwent a repair of the mitral valve, and 99 patients underwent a replacement of the mitral valve.

Patients who underwent replacement were older (mean age was 67±15), and with more comorbidities.

All patients were prospectively followed and long term clinical and echocardiographic outcomes were compared and analyzed.

RESULTS:

Hospital mortality was 0(0%) in the repair group and 5(5%) in the replacement group (p=0.069). At a mean FU of 70 months (range 1- 202 months) survival was 98% in the repair group and 70% in the replacement group (p=0.000). New York Heart Association assessment revealed freedom from function class III-IV of 85% in the repair group versus 80% in the replacement group (p= 0.567). Freedom from reoperation on the mitral valve was 92% versus 97% in the repair and replacement group respectively (p=0.182). Late echocardiography revealed freedom from moderate or severe MR to be 89% versus 99% in the repair group and the replacement group respectively (p=0.023).

CONCLUSIONS:

Mitral Valve repair in the degenerative anterior leaflet is associated with good clinical and echocardiographic outcomes comparable to replacement of the mitral valve. These findings emphasize the importance of the repair as the treatment of choice whenever feasible.