Long-Term Results of Edge-to-Edge Mitral Valve Repair in Degenerative Mitral Valve Disease: A Single-Center Experience

Objectives: Different sophisticated repair techniques have been established for the tailored treatment of primary mitral regurgitation. The Edge-to-Edge mitral valve repair has been somehow discredited in the past but has seen a revival recently for complicated Barlow disease. The aim of the present study was to assess the long-term results of this repair technique.

Methods: Between March 1999 and July 2019, a total of 153 patients (mean age, 60 ± 12.9 years), received an edge-to-edge repair and annuloplasty for regurgitation in degenerative mitral valve disease at our institution. Mitral regurgitation resulted from posterior leaflet prolapse in 23 patients (15%), anterior leaflet prolapse in 19 patients (12.4%), and bileaflet prolapse in 111 patients (72.6%). Of those who had a prolapse of both leaflets, 92 had a Barlow’s disease. Follow-up was complete in 96.1% (mean, 6.3 ± 5.7 years; longest duration, 18.4 years). Echocardiographic assessment was achieved in 85.5% (mean, 5.1 ± 5.6 years; median, 1.6 years; range from 30 days to 18.4 years). Preoperative, periprocedural and postoperative data were prospectively collected in a dedicated database and analyzed retrospectively.

Results: A 30-day mortality was 0.6%. At 10 years, the overall survival was 73.4 ± 5.1%, and the cumulative incidence of valve related reoperation was 5.1 ± 2.5%. During follow-up, 10 patients required a mitral valve-related reoperation due to ring dehiscence (n = 2), leaflet suture dehiscence (n = 2), and progression of native valve disease (n = 6). Additionally, two patients required reoperation due to device failure (ring fracture) which were not included in the analysis. At latest echocardiographic follow-up three patients presented with more than moderate mitral regurgitation. The mean pressure gradient across the mitral valve was 2.9 ± 1.3 mm Hg at discharge and 2.4 ± 1.3 mm Hg at latest echocardiographic follow-up. Nearly all (140 of 147, 95.2%) patients were in New York Heart Association (NYHA) class I or II.

Conclusion: Edge-to-Edge mitral valve repair is a simple and reproducible method with excellent long-term results particular in patients with Barlow’s disease.

No conflict of interest has been declared by the author(s).