Minimally Invasive Mitral Valve Repair versus Replacement for Mitral Valve Regurgitation

Objective: The aim of our study was to compare the characteristics of patients with mitral valve (MV) regurgitation (MR) who underwent minimally invasive replacement and repair, respectively, and to present their clinical outcomes.

Methods: Between February 2009 and October 2015, a total of 1162 consecutive patients underwent isolated minimally invasive MV surgery for MR. Patients who underwent percutaneous mitral valve repair or who had MV stenosis or history of endocarditis were excluded. MV repair techniques included pre-measured ePTFE-loops technique with (n = 872) and without (n = 2) annuloplasty, leaflet resection with annuloplasty (n = 23) and isolated annuloplasty (n = 114). MV replacements included biological prostheses (n = 112) and mechanical prostheses (n = 39). Patients were divided into 4 groups: repair (n = 916) versus replacement (n = 87) for prolapsing MR, repair (n = 95) versus replacement (n = 64) for non-prolapsing MR. Demographic and clinical characteristics were compared between groups. Logistic regression analysis was performed to identify factors associated with MV repair or replacement. Cox proportional hazards regression analysis was performed to identify factors associated with survival.

Results: Repair rate for prolapsing MR was 91.3% and for non-prolapsing MR 59.1%. In the prolapsing MR group, the replacement group were older (64.5 ± 13.0 vs. 59.5 ± 12.4 years; mean ± SD) and more symptomatic (NYHA class III–IV 52.9 vs. 36.0%) and showed more tricuspid valve regurgitation (TR) (grade II–III: 11.4 vs. 4.1%). Advanced age and TR-grade were associated with an increased probability of replacement. Survival estimated at 5 years was 95.8% after repair and 87.6% after replacement (p = 0.09). Age, NYHA and left atrial diameter were associated with survival. In the non-prolapsing MR group, the repair group did not differ from the replacement group according to preoperative parameters. Survival estimated at 5 years was 82.3% after repair and 57.2% after replacement (p = 0.03). Age, NYHA and types of surgical procedures were associated with survival. There was no significant difference in freedom from reoperation after repair and replacement between the two groups.

Conclusion: Our data demonstrate that MV replacement does not necessarily diminish long-term survival in patients with complicated prolapsing MR. Although achieving high repair rate for non-prolapsing MR is challenging, if performed, MV repair is associated with better survival rates than MV replacement.

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