Long-Term Outcomes of Mitral Valve Repair in Degenerative Valve Disease: Comparison Between Posterior and Anterior or Bileaflet Mitral Valve Prolapse

Background: The aim of this study was to compare the clinical and echocardiographic outcomes of mitral valve repair for degenerative mitral regurgitation in patients with posterior versus anterior or bileaflet mitral valve prolapse.Methods: Between April 1997 and July 2013, 255 patients underwent surgery for moderate to severe degenerative mitral regurgitation: 175 had posterior mitral valve prolapse (Group 1) and 80 had anterior or bileaflet prolapse (Group 2). There were no differences in age or sex between the groups. Clinical follow-up was completed in 95% of patients (mean 5.6 ± 3.8 years) and echocardiographic follow-up in 77% (mean 4.8 ± 3.7 years).Results: Repair was successful in 87% of cases (33 intraoperative conversions to valve replacement) (Group 1: 98% vs. Group 2: 62.5%; p<0.01). In-hospital mortality was 2.3% (6/255). Ten-year survival was 92.0 ± 2.1% (Group 1: 94.4 ± 2.2% vs. Group 2: 86.3 ± 5.1%; p=0.036). At 10 years, 95.6 ± 1.6% were free from reoperation (Group 1: 97.1 ± 1.4% vs. Group 2: 89.7 ± 5.0%; p=0.035), 79.0 ± 4.4% remained free from moderate-to-severe mitral regurgitation (Group 1: 80.8 ± 4.8% vs. Group 2: 71.9 ± 9.6%; p=0.14), and 91.2% were asymptomatic (92% Group 1 vs. 89.3% Group 2; p=0.5).Conclusions: Patients with posterior mitral valve prolapse had higher survival and lower reoperation rates after repair. Freedom from moderate-to-severe regurgitation at 10 years was similar between groups.