Should annuloplasty prosthesis be selected dependent on the location of prolapse in mitral valve repair for type II dysfunction?

OBJECTIVE

This study explored the influence of prosthesis selection on long-term outcomes in patients who underwent mitral valve repair for mitral insufficiency (MI) due to type II dysfunction.

METHODS

We retrospectively reviewed 452 patients with MI who underwent mitral valve repair for type II dysfunction between 2001 and 2014. Of these, 167 patients (37%) presented with anterior leaflet prolapse (anterior group) and 285 (63%) presented with posterior prolapse (posterior group). Full rings were applied in 95 patients (57%) in the anterior group and in 54 patients (19%) in the posterior group, and partial bands were applied in all others. We compared long-term outcome and change of MI severity over time between patients with partial-band and full-ring repair in the anterior and in the posterior groups using a mixed-effect model with repeated measures and propensity score-matched analysis.

RESULTS

Ten-year survival of the cohort was 90.5%. Echocardiography revealed MI ≥ 3 at follow-up in 58 patients (12.8%). Twenty-one patients (4.6%) required reoperation; freedom from reoperation was 92.1% at 10 years. The MI severity over time in patients in the anterior group was higher than that in patients in the posterior group (P < .0001). Moreover, MI severity over time in patients with the partial band was higher than patients with the full ring in the anterior group (P = .0176). Propensity score-matched analysis in the anterior group, but not in the posterior group, revealed a significantly higher MI severity in patients with the partial band than those with the full ring over the study period (P = .04).

CONCLUSIONS

Full-ring annuloplasty is indicated in the setting of anterior prolapse to prevent recurrent MI, whereas prosthesis type is not a determinant of recurrent MI in the setting of posterior prolapse.