Should annuloplasty prosthesis be selected dependent on the location of prolapse in mitral valve repair for type II dysfunction?

OBJECTIVE: This study explored the influence of prosthesis selection on long-term outcomes in patients who underwent mitral valve repair for mitral insufficiency (MI) due to type II dysfunction.

METHODS: We retrospectively reviewed 452 patients with MI who underwent mitral valve repair for type II dysfunction between 2001 and 2014. Of these, 167 patients (37%) presented with anterior leaflet prolapse (anterior group) and 285 (63%) presented with posterior prolapse (posterior group). Full rings were applied in 95 patients (57%) in the anterior group and in 54 patients (19%) in the posterior group, and partial bands were applied in all others. We compared long-term outcome and change of MI severity over time between patients with partial-band and full-ring repair in the anterior and in the posterior groups using a mixed-effect model with repeated measures and propensity score-matched analysis.

RESULTS: Ten-year survival of the cohort was 90.5%. Echocardiography revealed MI ≥ 3 at follow-up in 58 patients (12.8%). Twenty-one patients (4.6%) required reoperation; freedom from reoperation was 92.1% at 10 years. The MI severity over time in patients in the anterior group was higher than that in patients in the posterior group (P < .0001). Moreover, MI severity over time in patients with the partial band was higher than patients with the full ring in the anterior group (P = .0176). Propensity score-matched analysis in the anterior group, but not in the posterior group, revealed a significantly higher MI severity in patients with the partial band than those with the full ring over the study period (P = .04).

CONCLUSIONS: Full-ring annuloplasty is indicated in the setting of anterior prolapse to prevent recurrent MI, whereas prosthesis type is not a determinant of recurrent MI in the setting of posterior prolapse.