Long-Term Results (≤ 18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation Implications for the Percutaneous Approach

Background-To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). Methods and Results-From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2+/-4.21 years; median, 9.7; longest, 18.1). Survival at 12 years was 51.3+/-7.75%. At the last echocardiographic examination, MR >= 3+ was demonstrated in 33 patients (55%). At 12 years, freedom from reoperation was 57.8+/-7.21% and freedom from recurrence of MR >= 3+ was 43+/-7.6%. Residual MR > 1+ at hospital discharge was identified as a risk factor for recurrence of MR >= 3+ (hazard ratio, 3.8; 95% confidence interval, 1.7-8.2; P=0.001). In patients with residual MR <= 1+ immediately after surgery, freedom from MR >= 3+ at 5 and 10 years was 80+/-6% and 64+/-7.58%, respectively. Conclusions-In degenerative MR, the overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. Early optimal competence (residual MR <= 1+) was associated with higher freedom from recurrent severe regurgitation.