• Tirone E David, Carolyn M David, Wendy Tsang, Myriam Lafreniere-Roula, and Cedric Manlhiot.
• Divisions of Cardiovascular Surgery and Cardiology of Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: tirone.david@uhn.ca.
• J. Am. Coll. Cardiol. 2019 Aug 27; 74 (8): 1044-1053.

BackgroundMitral valve (MV) repair has become the standard therapy for mitral regurgitation (MR) due to degenerative diseases, but information on late outcomes is limited.ObjectivesThe purpose of this study was to examine the late results of MV repair for MR in a large cohort of patients.MethodsA total of 1,234 consecutive patients (median age 59 years; 70.4% men) had MV repair for MR due to leaflet prolapse and were followed prospectively for a median of 13 years (interquartile range: 8 to 34 years) with periodical echocardiographic studies. There were 163 patients still at risk at 20 years. Cumulative incidences of adverse events and associated factors were examined with death as a competing outcome.ResultsAt 20 years, reoperation-free survival was 60.4% (95% confidence interval: 56.2% to 64.2%) and the cumulative incidence of cardiac and valve-related deaths was 12%, noncardiac deaths 21.3%, reoperation on the MV 4.6%, infective endocarditis 1.1%, thromboembolism 10.3%, and bleeding 6.4%. The probability of recurrent moderate or severe MR was 12.5%, persistent or new moderate or severe tricuspid regurgitation (TR) 20.8%, and new atrial fibrillation (AF) 32.4%. Multivariable analysis identified older age, complete heart block, MV repair without annuloplasty ring, and the degree of myxomatous degeneration of the MV to be associated with recurrent MR. The development of AF and TR was unrelated to recurrent MR.ConclusionsMV reoperation was uncommon after MV repair, but there was an increasing incidence of recurrent MR, TR, and new AF over time.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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