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37. A comparison of outcomes of mitral valve repair for anterior and posterior leaflet prolapse due to degenerative disease
Tirone E David, Joan Ivanov, Susan Armstrong, Debbie Christie; Toronto, ON, Canada
Objective: To compare the clinical and echocardiographic outcomes of mitral valve repair for anterior (AL) or posterior leaflet (PL) prolapse.
Methods: All patients who had mitral valve repair for degenerative disease with isolated AL or PL prolapse were reviewed. Patients with bileaflet prolapse were excluded. There were 92 AL and 359 PL prolapse. Patients with AL prolapse were younger (53 ± 15 vs. 60 ± 12 years, p=0.0001), and had more associated aortic valve disease (17% vs. 4%, p=0.001), particularly bicuspid aortic valve disease (p=0.001). Chordal shortening, chordal transfer, or chordal replacement with Gore-Tex sutures were used to correct AL prolapse. Echocardiograms were done annually. The mean follow-up was 7 ± 4 years and it was complete.
Results: See Table for Kaplan-Meier estimates of longitudinal outcomes. Eight patients with AL and 10 with PL were reoperated on because of recurrent severe MR (4+) and/or hemolysis. AL prolapse was an independent predictor of reoperation (risk ratio 3.01, 95% CI 1.2-7.6). Six patients with AL prolapse developed severe MR and 13 moderate MR.
Conclusions: The durability of mitral valve repair for isolated PL prolapse due to degenerative disease is significantly better than for AL prolapse.
Kaplan-Meier estimates of survival and freedom from morbid events
|
|
5- year |
10-year |
15-year |
p value |
| Survival: |
AL |
85 ± 4% |
74 ± 6% |
74 ± 6% |
|
|
PL |
94 ± 1% |
79 ± 3% |
59 ± 6% |
0.5 |
| Freedom from cardiac death: |
AL |
96 ± 3% |
93 ± 4% |
93 ± 4% |
|
|
PL |
98 ± 1% |
93 ± 2% |
86 ± 5% |
0.6 |
| Freedom from 3+ or 4+ MR: |
AL |
85 ± 4% |
76 ± 6% |
40 ± 13% |
|
|
PL |
97 ± 1% |
86 ± 3% |
70 ± 7% |
0.0004 |
| Freedom from re-operation: |
AL |
93 ± 3% |
88 ± 4% |
88 ± 4% |
|
|
PL |
98 ± 12% |
96 ± 1% |
95 ± 2% |
0.008 |
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