Population-Based Analysis of Late Outcomes of Mitral Valve Repair for Degenerative Mitral Valve Regurgitation

BACKGROUND Population-based analyses may reduce uncertainty related to referral bias and/or incomplete follow-up. OBJECTIVES This study analyzed long-term mortality and durability of mitral valve repair in a geographically defined population with clinical and echocardiographic follow-up. METHODS We used the Rochester Epidemiology Project to identify 153 Olmsted County patients who underwent mitral valve repair for degenerative regurgitation from 1993 to 2018. Survival was compared to a gender-and age-matched U.S. population using the Kaplan-Meier method. Cumulative incidence and repeat operation rates were estimated, accounting for the completing risk of death. RESULTS The median age of the cohort was 61 years (IQR: 53-73 years), 112 patients (73%) were men, and the left ventricular ejection fraction was 65% (IQR: 60%-69%). Triangular resection of the P2 scallop combined with a 63 mm posterior band annuloplasty was performed in 108 (71%) patients. The median clinical follow-up was 13.8 years (IQR: 11.5-16.2 years), while echocardiography follow-up was available in 152 (99%) patients at 6.6 years (IQR: 1.3-12.8 years). The probability of developing severe mitral regurgitation was 4% (IQR: 3%-7%) in 9 years. Cumulative incidence of repeat mitral valve operation was 8% (n 1/4 10) at 20 years. The probability of developing severe tricuspid regurgitation was 5% (IQR: 4%-8%) in 10 years, but no subsequent tricuspid valve operation was performed. Survival following mitral valve repair was superior to an age-and sex-matched control population (P < 0.001). CONCLUSIONS Mitral valve repair for degenerative disease is durable with exceedingly low repeat operation and mortality up to 20 years of follow-up. There was also a low rate of subsequent development of significant tricuspid valve regurgitation. (JACC Adv. 2024;3:101398) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).