Long-term outcomes of mitral valve repair for isolated commissural prolapse: up to 17-year experience.

BACKGROUND

Mitral valve repair has been shown to be effective for degenerative mitral regurgitation (MR). However, outcomes of mitral valve repair for commissural prolapse has not been well defined. Commissural prolapse has been often categorized into the groups of posterior leaflet prolapse or bileaflet prolapse, and outcomes and prognosis of isolated commissural prolapse has been rarely reported. We aimed to determine clinical and echocardiographic outcomes of mitral valve repair for isolated commissural lesion.

METHODS

Between 1992 and 2010, 1,112 patients underwent mitral valve repair for degenerative MR at our institution. Among those, we reviewed 122 patients with isolated commissural prolapse. We analyzed operative outcomes, long-term survival rate, freedom from reoperation rate, and freedom from recurrent moderate or severe MR rate.

RESULTS

The mean age was 57.0 ± 14.4 years old, 83 patients (68.0%) were men, 16 patients (13.1%) had infective endocarditis, 43 patients (35.2%) had atrial fibrillation, 27 patients (22.1%) had anterolateral commissural prolapse, 91 (74.6%) had posteromedial commissural prolapse, and 4 (3.3%) had bilateral commissural prolapse. We performed leaflet resection in 111 (91.0%) (concomitant sliding plasty in 43), chordal replacement in 94 (77.0%), and ring annuloplasty in 121 patients (99.2%). Residual mild MR was confirmed in 7 patients (5.7%) on predischarge echocardiography. No patients had moderate or severe MR at the time of discharge. Fifteen-year survival and freedom from mitral reoperation were 87.6% and 93.0%, respectively. Freedom from recurrent moderate or severe MR at 15 years was 87.4%.

CONCLUSIONS

Mitral valve repair for isolated commissural prolapse demonstrated excellent early and late outcomes.