Minimally Invasive Mitral Valve Repair for Commissural Prolapse: Safety, Success, and Long-Term Efficacy

TL;DR

This study shows that minimally invasive surgery for a rare heart valve issue called commissural prolapse is safe and effective, with outcomes similar to a more common condition.

Contribution

Demonstrates the safety and long-term efficacy of minimally invasive mitral valve repair for commissural prolapse compared to posterior leaflet prolapse.

Findings

Minimally invasive mitral valve repair for commissural prolapse had comparable 30-day mortality and stroke rates to posterior leaflet prolapse.

Long-term outcomes like MR recurrence, reoperation, and survival were similar between commissural prolapse and posterior leaflet prolapse patients.

Despite longer operative times and hospital stays, commissural prolapse repair was found to be durable and successful.

Abstract

Commissural prolapse (CP) is a rare and complex mitral valve pathology which is complicated in preoperative diagnosis and repair. This study evaluated the safety, success, and long-term efficacy of minimally invasive mitral valve repair (MIMVR) for CP compared to posterior leaflet prolapse (PMLp).

Between 2001 and 2022, 34 patients with CP and 590 with PMLp underwent MIMVR at our centre. Operative, perioperative, and long-term follow-up data were retrospectively collected. Surgical success was defined as freedom from conversion to valve replacement, sternotomy, and residual mitral regurgitation (MR) > grade I. Long-term efficacy included MR recurrence, reoperation, and survival.

Median age was similar (CP: 64.0 years [53.2; 69.8] vs PMLp: 62.0 years [53.0; 69.0], P = .783). Barlow’s disease was more frequent in PMLp (80.3% vs 32.4%, P < .001). Cross-clamp (127.0 min vs 105.0 min, P = .001) and bypass times (208.5 min vs 190.5 min, P = .031) were longer in CP. CP patients had longer hospital stays (10.0 days [8.0; 12.0] vs 8.0 days [7.0; 9.0], P < .001), but short-term outcomes, including 30-day mortality, stroke, and extracorporeal membrane oxygenation support, were comparable. At a median follow-up of 4.5 years (CP) and 2.4 years (PMLp, P = .001), rates of recurrent MR, reoperation, and survival were similar.

MIMVR for CP is safe, successful, and durable with outcomes comparable to PMLp. Despite greater technical complexity and longer operative times, this approach provides reliable results for CP.

Barlow’s disease is a primary degenerative mitral valve disorder in which myxoid infiltration of the valve results in excess leaflet tissue, different phenotypes of chordal anatomy ranging from normal to elongated or ruptured chords and bileaflet prolapse.

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