Commissural closure to treat severe mitral regurgitation: standing the test of time

D. Carino*, R. Lorusso, E. Lapenna, B. Del Forno, A. Sala, E. Zancanaro, S. Ruggeri, S. Abboud, D. Schiavi, G. Ascione, A. Castiglioni, O. Alfieri, F. Maisano, M. De Bonis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study.METHODS A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997-2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data.RESULTS A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 +/- 2.57% (95% confidence interval [3.88-13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 +/- 1.98%, 95% confidence interval [2.04-9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR >= 3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected.CONCLUSIONS Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR >= 3+ recurrence.
Original languageEnglish
Number of pages6
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume62
Issue number1
Early online date12 Mar 2022
DOIs
Publication statusPublished - 15 Jun 2022

Keywords

  • Mitral valve repair
  • Mitral regurgitation
  • Edge to edge mitral repair
  • Commissural prolapse
  • VALVE REPAIR
  • PROLAPSE
  • LEAFLET
  • POSTERIOR
  • ANTERIOR
  • OUTCOMES

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