Rubino Antonino S, Mignosa Carmelo, Di Bartolo Massimo, Cavallaro Alfio, Castorina Sergio, Gentile Maurizio, Patanè Leonardo
U.O.C. Cardiochirurgia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "Luigi Vanvitelli", Napoli - U.F. Cardiochirurgia, Dipartimento di Cardiologia e Chirurgia CardioVascolare, Centro Clinico Diagnostico "G.B. Morgagni", Centro Cuore, Pedara (CT).
U.F. Cardiochirurgia, Dipartimento di Cardiologia e Chirurgia CardioVascolare, Centro Clinico Diagnostico "G.B. Morgagni", Centro Cuore, Pedara (CT) - Dipartimento di Cardiochirurgia, ISMeTT/UPMC, Palermo.
G Ital Cardiol (Rome). 2020 Mar;21(3):209-215. doi: 10.1714/3306.32769.
To evaluate the long-term clinical and echocardiographic performance of mitral valve repair with the edge-to-edge technique.
In-hospital results, actuarial freedom from all-cause mortality, cumulative incidence of cardiovascular mortality, recurrent mitral regurgitation ≥3+ and reoperation on the mitral valve were assessed in 180 consecutive patients undergoing mitral repair with the edge-to-edge technique for degenerative or functional regurgitation. Exercise echocardiography was performed in 24 patients to assess valve hemodynamics in the long-term follow-up.
The edge-to-edge repair was applied as a first strategy in 157 patients (87.2%) or as a bail-out procedure in 23 patients (12.8%). At discharge, mitral regurgitation grade was absent in 152 patients (84.4%) and trivial in 28 patients (15.6%). Mean gradient was 2.8 ± 0.6 mmHg and effective orifice area was 2.9 ± 0.4 cm2. After a median follow-up of 6.5 (interquartile range 3.5-10.2) years, 93.6% patients were in NYHA functional class I-II. Actuarial survival at 15 years was 89.2 ± 2.7%, whereas the cumulative incidence of cardiovascular mortality was 7.0%, of recurrent mitral regurgitation ≥3+ 12.6% and of reoperation on the mitral valve 3.2%. Exercise stress echocardiography revealed a significant increase of functional area (3.1 ± 0.3 vs 4.0 ± 0.6 cm2, p<0.001) and mean gradients (2.7 ± 0.4 vs 4.6 ± 1.2 mmHg, p<0.001).
The edge-to-edge technique effectively corrects degenerative and functional mitral regurgitation and represents a valid bail-out procedure in case other approaches failed to achieve adequate intraoperative valve competence. Long-term results are sustained up to 15 years, with significant improvement in functional status. Despite an altered geometry, the occurrence of iatrogenic mitral stenosis is avoided even at high workload conditions.
