Mid-term outcomes of simultaneous mitral valve repair in patients with miral regurgitation and concomitant annulo-aortic ectasia

Clinical results of combined aortic valve-sparing root replacement and mitral valve repair

OBJECTIVES

Aortic valve-sparing root replacement using the reimplantation technique and mitral valve (MV) repair are well-established surgical approaches for the treatment of aortic root pathologies and mitral valve insufficiency. However, the management of concomitant diseases with a dual valve-preserving strategy remains poorly described. Therefore, the aim of this study is to evaluate the long-term outcomes of concomitant valve-sparing surgery and MV repair.

METHODS

This case series includes all the patients who underwent combined valve-sparing root replacement and MV repair at Cliniques Universitaires Saint-Luc (Brussels, Belgium) between January 2000 and June 2022. Actual survival rate and freedom from reoperation were calculated by the Kaplan-Meier method, and the log rank test was used for statistical evaluation.

RESULTS

Forty-five patients were included in the study; they were divided into two groups (13 patients with and 32 patients without connective tissue disorders). There was no hospital mortality. Three patients (7%) required pacemaker implantation. Overall survival at 10 years was 90% (95% confidence interval [CI]: 64-97%). Furthermore, freedom from all reoperations at 10 years was 84% (95% CI: 64-93%). Analysing the two subgroups, we found no statistically significant difference in terms of 10-year survival (log rank P = 0.146). However, freedom from reoperation at 10 years was significantly lower in the connective tissue disorder group (63% vs 91%, log rank P = 0.031). Most patients treated with transaortic edge-to-edge repair required MV reoperation.

CONCLUSIONS

Combined valve-sparing root replacement with the reimplantation technique and MV operations are complex surgeries. However, they can be performed safely, with excellent long-term survival and repair durability. Applying standard Carpentier techniques for MV repair is crucial, especially in patients with connective tissue disorders.

Long-term outcomes following valve-sparing root replacement with concomitant mitral repair

OBJECTIVES

To examine the late outcomes of valve-sparing root replacement and concomitant mitral valve repair in patients who have been followed prospectively for more than 2 decades.

METHODS

From 1992 to 2020, 54 consecutive patients (mean age, 47 ± 16 years; 80% men) underwent valve-sparing root replacement (45 reimplantation and 9 remodeling) with concomitant repair of the mitral valve. Patients were followed prospectively for a median of 9 years (IQR, 3-14 years).

RESULTS

No patient experienced perioperative death or stroke. There were 3 late deaths and the 15-year overall survival was 96.0% (95% CI, 74.8%-99.4%), similar to the age- and sex-matched population. Over the follow-up period, 6 patients had reoperation of the aortic valve and 3 on the mitral valve. Of those, 2 had reoperation on both aortic and mitral valves for a total of 7 reoperations in this cohort. The cumulative proportion of reoperation at 10 years of either or both valves were as follows: aortic valve 11.4% (95% CI, 3.9%-33.3%), mitral valve 4.2% (95% CI, 0.6%-28.4%), and both valves 11.4% (95% CI, 3.9%-33.3%). The estimated probability of developing moderate/severe aortic insufficiency at 15 years was 18.5% (95% CI, 9.0%-34.2%). On final echocardiographic follow-up, none of the patients had developed moderate/severe mitral regurgitation.

CONCLUSIONS

In this single-center series of concomitant valve-sparing root replacement and mitral valve repair, we observed excellent clinical outcomes with a low risk of death or valve-related complications. Continued surveillance of late valve function is necessary.

Mitral Valve Repair Is Effective When Performed With Valve-Sparing Aortic Root Replacement

Background

Concurrent aortic and mitral valve repair presents specific technical challenges to surgeons. Here we evaluate the outcomes of patients undergoing combined valve-sparing aortic root reimplantation and mitral valve repair.

Methods

We performed a retrospective review of patients at our center between 2006 and 2021 who underwent concomitant valve-sparing aortic root replacement and mitral valve repair. Patient characteristics, including preoperative and postoperative valve function, and operative outcomes were analyzed.

Results

Between 2006 and 2021, 14 patients underwent valve-sparing aortic root replacement with concurrent mitral valve repair. Mean age of the patients at operation was 39 ± 20 years. Almost half of the patients (6/14) had Marfan disease. The primary indication for operation in all patients was aortic root dilation. Preoperatively, all patients (14/14) had moderate to severe mitral regurgitation, and half (7/14) had moderate to severe aortic regurgitation. Patients underwent mitral annuloplasty alone (9/14) or had concurrent leaflet repair (5/14). The median length of intubation was 0 day (interquartile range, 0-1 day), and median length of stay was 7 days (interquartile range, 6-10 days). At average follow-up of 6.8 ± 4.2 years, 13 of 14 patients had none to trace aortic and mitral regurgitation. One patient required reoperation for late recurrence of aortic and mitral regurgitation. There was no early or late cardiovascular mortality.

Conclusions

Mitral valve repair can be performed safely with excellent short-term and long-term results in selected patients undergoing valve-sparing aortic root reimplantation. For durable bivalvular repair to be achieved, specific technical considerations should be adhered to.