Commissural closure to treat severe mitral regurgitation: standing the test of time

Eur J Cardiothorac Surg. 2022 Jun 15;62(1):ezac135. doi: 10.1093/ejcts/ezac135.

Abstract

Objectives: Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study.

Methods: A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997-2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data.

Results: A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 ± 2.57% (95% confidence interval [3.88-13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 ± 1.98%, 95% confidence interval [2.04-9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR ≥3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected.

Conclusions: Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR ≥3+ recurrence.

Keywords: Commissural prolapse; Edge to edge mitral repair; Mitral regurgitation; Mitral valve repair.

MeSH terms

  • Humans
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Mitral Valve Annuloplasty* / adverse effects
  • Mitral Valve Annuloplasty* / methods
  • Mitral Valve Insufficiency*
  • Mitral Valve Prolapse* / complications
  • Mitral Valve Prolapse* / surgery
  • Prolapse
  • Reoperation / adverse effects
  • Retrospective Studies
  • Treatment Outcome