10 How Successful is Mitral Valve Repair for Patients with Bi-Leaflet Prolapse?

Background Severe Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is ideally treated with Mitral Valve Repair. Those patients with Bi-leaflet prolapse (BLP) are a challenging subgroup to repair and the long term outcomes and durability of repairs in BLP versus single-leaflet prolapse (SLP) need to be defined. Methods Between year 2011 and 2018, a total of 346 patients underwent mitral valve repair by a single surgeon. 238 of these were repairs for degenerative MR with various leaflet prolapse aetiologies. Mean age ± Standard deviation [SD] was 64.11±12.3 years. Results SLP represents 70% in this cohort and BLP 30%. Both cross clamp time (68.11±3.85 vs. 57.45±2.00 mins, p=0.009) and bypass time (91.19±4.6 vs. 79.76±2.11 mins, p=0.01) were longer in BLP versus SLP. Successful repair in this cohort was 98% with a mean follow up of 3.7±0.2 years (range: 3 months – 7 years). Overall, the freedom from reoperation (FFReop) at 5-years was 92.4±4.0% for the entire cohort. There was no significant difference in FFReop between SLP repair versus BLP repair (p=0.78). At 7-year, the FFReop in BLP was comparable to SLP repair (93.1% vs. 91.6%). The overall survival rate at 5-year was 89.2±4.3%. There was no significant difference in the long-term survival rate between BLP vs. SLP (p=0.49). On univariate analysis, neither SLP nor BLP were predictive of reoperation (HR=1.5, p=0.37) or survival (HR=1.2, p=0.60). On multi-variate analysis, only pre-discharge MR status on echo (HR=39.9, p=0.02) was associated with reoperation, while only age (HR=1.3, p=0.03) and NYHA status pre-op (HR=10.5, p=0.06) were predictive of future survival. Conclusions Mitral valve repair provides excellent durability and the long term survival is similar to the normal population. Patients with severe MR due to Bi-leaflet prolapse can be successfully repaired in specialist centres with outcomes and durability comparable to Single leaflet repairs.