PMID- 26792923 OWN - NLM STAT- MEDLINE DCOM- 20170321 LR - 20191210 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 50 IP - 1 DP - 2016 Jul TI - Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival. PG - 66-74 LID - 10.1093/ejcts/ezv470 [doi] AB - OBJECTIVES: To evaluate the feasibility of mitral valve repair in patients with anterior leaflet (ALP) or bileaflet prolapse (BLP) and identify factors predisposing patients to replacement. To compare long-term survival of patients submitted to repair (Group Repair) against those submitted to replacement (Group Replacement), and investigate causes of early and late failures of repair. METHODS: From January 1992 through December 2012, 768 patients with ALP or BLP were submitted to mitral valve surgery, of whom 501 had degenerative involvement [Myxomatous (Myx)-336 (67.1%) or fibroelastic deficiency (Fed)-165 (32.9%)] and constituted the study population. Isolated ALP was present in 274 patients (54.7%) and BLP in 227 (45.3%). Associated procedures were admitted. RESULTS: Patients with Fed were significantly older (64.4 +/- 12.1 vs 54.8 +/- 15.5 years, P < 0.001), more symptomatic (63 vs 44.3%; P < 0.001) and with higher incidence of atrial fibrillation (43.6 vs 26.2%; P < 0.001). Repair was achieved in 94.8% of patients with an overall 30-day mortality rate of 1.2% (0.3% in the last decade) and no differences regarding aetiology. Age, moderate to severe left ventricular (LV) dysfunction, previous cardiac surgery, multiple segment prolapse, mitral calcification, leaflet retraction and the performing surgeon were independently associated with replacement. Group Repair patients had a greater adjusted 20-year survival by comparison with Group Replacement (43.4 +/- 5.5 vs 13.6 +/- 11.3%; P < 0.001) and similar to that of the age- and sex-adjusted general population (P = 0.10). Valve replacement, New York Heart Association (NYHA) class III-IV, pulmonary hypertension and LV dysfunction emerged as independent predictors of late mortality. Patients in NYHA class I-II experienced a higher repair rate (98.4%) and better survival than those in Class III-IV. Two repair patients were reoperated during the first year after surgery (early failure) and both were 'rerepaired'. Late failure was observed in 21 patients, mostly for progression of the disease. The 20-year rate of freedom from reoperation was 88 +/- 2.7%, significantly worse in ALP patients (P = 0.040), and not different between Fed and Myx. CONCLUSIONS: Patients with ALP or BLP can be submitted to surgery with low mortality and great probability of repair in expert hands. Patients should be operated on at an early phase (asymptomatic or mildly symptomatic), because there is a higher probability of repair and greater benefit on long-term survival. CI - (c) The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Coutinho, Goncalo F AU - Coutinho GF AD - Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal. FAU - Correia, Pedro M AU - Correia PM AD - Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal. FAU - Branco, Carlos AU - Branco C AD - Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal. FAU - Antunes, Manuel J AU - Antunes MJ AD - Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal antunes.cct.chuc@sapo.pt. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20160119 PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Female MH - *Heart Valve Prosthesis MH - Heart Valve Prosthesis Implantation/methods/mortality MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve/surgery MH - Mitral Valve Annuloplasty/*methods/mortality MH - Mitral Valve Insufficiency/mortality/*surgery MH - Mitral Valve Prolapse/mortality/*surgery MH - Postoperative Complications/etiology MH - Reoperation/statistics & numerical data MH - Risk Factors MH - Treatment Outcome OTO - NOTNLM OT - Bileaflet prolapse OT - Leaflet prolapse OT - Mitral valve regurgitation OT - Mitral valve repair OT - Mitral valve replacement EDAT- 2016/01/23 06:00 MHDA- 2017/03/23 06:00 CRDT- 2016/01/22 06:00 PHST- 2015/09/07 00:00 [received] PHST- 2015/12/04 00:00 [accepted] PHST- 2016/01/22 06:00 [entrez] PHST- 2016/01/23 06:00 [pubmed] PHST- 2017/03/23 06:00 [medline] AID - ezv470 [pii] AID - 10.1093/ejcts/ezv470 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2016 Jul;50(1):66-74. doi: 10.1093/ejcts/ezv470. Epub 2016 Jan 19.