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Complete rings or posterior bands are both commonly used during mitral valve repair, but which one ensures the best long-term outcome in patients with Barlow disease is a topic of debate. This study evaluated whether the type of annuloplasty device affects the long-term durability of the repair.We selected 296 consecutive patients with severe mitral regurgitation due to Barlow disease who underwent edge-to-edge mitral repair at our institution between 2004 and 2013. For the edge-to-edge repair, a complete semirigid ring was used in 151 patients, whereas a posterior flexible band was used in 145 patients. The clinical and echocardiographic outcomes of both groups were compared at long-term follow-up.At 14 years, the overall survival was 87.3% ± 2.79% in the ring group and 94.1% ± 2.30% in the band group (P = .056). The incidence of mitral valve reintervention was 4.9% ± 1.95% in the ring group and 5.5% ± 2.53% in the band group (P = .371) at 14 years. The incidence of recurrence of mitral regurgitation ≥3+ and ≥2+ was 8.3% ± 2.64% in the ring group and 8.7% ± 3.07% in the band group (P = .991) and 26.5% ± 4.23% in the ring group and 17.4% ± 3.26% in the band group (P = .697), respectively. Mitral regurgitation ≥1+ at discharge was the only independent predictor of reoperation and recurrence of mitral regurgitation ≥3+ in the long-term.In patients with Barlow disease undergoing edge-to-edge mitral valve repair, the type of annuloplasty device does not influence the long-term results. Achieving an optimal immediate result remains the key to maintain the stability of the repair at long-term.

Background We report the long-term (19 years) clinical and echocardiographic results of the quadrangular resection with annular plication and annuloplasty. Methods Included were 145 consecutive patients (mean age, 58 ± 11.1 years; left ventricular ejection fraction, 0.59 ± 0.095) with severe degenerative mitral regurgitation due to posterior leaflet prolapse/flail who underwent quadrangular resection of the posterior leaflet combined with ring (127 patients [87.5%]) or pericardium (18 patients [12.5%]) annuloplasty. Results No hospital deaths occurred. At hospital discharge, all patients but 1 had none or trivial mitral regurgitation. Follow-up was 97% complete (median, 19 years; interquartile range, 18 to 20 years). At 20 years, the overall survival was 74% ± 3.7%. At 19 years, cumulative incidence function of cardiac death with noncardiac death as a competing risk was 9.9% ± 2.5% (95% confidence interval [CI], 5.7% to 15.5%). Age was the only significant predictor of cardiac death (hazard ratio, 1.1; 95% CI, 1.0 to 1.1; p = 0.01) at multivariate analysis. Only 6 patients (4%) were reoperated on for recurrent severe mitral regurgitation. At 19 years, cumulative incidence function of reoperation and recurrence of mitral regurgitation 3+ or higher with death as a competing risk was 4.3% ± 1.7% (95% CI, 1.7% to 8.8%) and 8.8% ± 2.8% (95% CI, 4.3% to 15.5%), respectively. Indeed, only 11 patients (8%) had recurrent mitral insufficiency 3+ or higher. No predictor of reoperation and recurrence of mitral regurgitation 3+ or higher was identified. At the last follow-up, moderate mitral regurgitation (2+/4+) was detected in 14 patients (10%). Conclusions Quadrangular resection with annular plication for posterior leaflet prolapse, combined with annuloplasty, is associated with a very low probability of reoperation and recurrent mitral regurgitation for up to 2 decades after the operation. These results provide reference values to which all of the other more recently introduced surgical and transcatheter options need to be compared.

BACKGROUND: The impact of a valve prosthesis-patient size mismatch is still controversial. In most studies, the inclusion of a large proportion of poorly active old patients with low cardiac output requirements may be misleading, due to the close correlation between trans-prosthetic gradients and cardiac output. The aim of this study was to assess the impact of small "functional" prosthesis sizes in active young to middle-age patients. METHODS: Eighty-three active patients with a mean age of 46 ± 8 years and a high health survey questionnaire score were followed for 80 ± 34 months after isolated aortic valve replacement with a mechanical prosthesis. RESULTS: Patients with an indexed, Doppler derived, effective orifice area index less than 0.85 cm2/m2 (0.77 ± 0.1 cm2/m2) showed higher early trans-prosthetic gradients (peak, 34 ± 11 vs 26 ± 8 mm Hg; P = 0.001) than patients with a larger effective orifice area index. However, significant regression of the left ventricular mass index and improvement of the left ventricular ejection fraction were observed in both groups at follow-up (119.8 ± 26 vs 165.2 ± 38 g/m2 and 128.5 ± 25 vs 181.8 ± 5 0 g/m2; P < 0.001; 58 ± 6 vs 52 ± 11% and 58 ± 7 vs 53 ± 10%; P < 0.001), with no differences between groups (P = 0.4 and P = 0.7, respectively). At multiple linear regression, the final left ventricular mass index was positively related to the preoperative left ventricular mass index (P = 0.004) and was unaffected by the effective orifice area index (P = 0.4). Symptomatic improvement (New York Heart Association class 1.3 ± 0.4 vs 2.4 ± 0.8 and 1.2 ± 0.4 vs 2.2 ± 0.8; P < 0.001) and freedom from late cardiac death (93 ± 3% and 95 ± 6%) were comparable between groups (P = 0.6 and P = 0.7, respectively). CONCLUSIONS: Our findings indicate that small "functional" prosthesis sizes with modern mechanical valves may not adversely affect outcomes of aortic valve replacement in young patients with high cardiac output requirements.