Intermediate results of transaortic edge-to-edge repair of the mitral valve in patients undergoing aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the safety and efficacy of a transaortic edge-to-edge mitral valve repair in patients undergoing aortic valve replacement (AVR) who were considered to be at high risk for double-valve surgery.

METHODS

All patients deemed to be at high surgical risk for standard double-valve surgery, and who instead underwent AVR with transaortic edge-to-edge mitral valve repair between September 2008 and October 2012 at the authors' institution, were analyzed retrospectively. Intraoperative transesophageal and follow-up transthoracic echocardiography were performed to evaluate adequacy of the repair and to assess for any recurrence of mitral regurgitation (MR).

RESULTS

A total of 55 patients (mean age 78.4 +/- 8.4 years) was identified (45 minimally invasive, 10 median sternotomy). All patients were in NYHA class III-IV. The aortic valve lesion was classified as stenosis (n = 45), insufficiency (n = 6), or prosthetic valve insufficiency (n = 4), and the mitral valve lesion as functional (n = 16), degenerative calcification (n = 27), or rheumatic (n = 12). There were four deaths (7%). The median total hospital length of stay was 7 days (IQR 6-11 days). The median preoperative versus postoperative MR grade was moderate-to-severe (3+) (IQR 3-4+) versus 0 (IQR 0-1+) (p < 0.001). The median time to follow up echocardiography was 6.5 months (IQR 0.8-12 months). The median preoperative and postoperative versus follow up MR grades were 3+ (IQR 3-4+) versus 1+ (IQR 0-1+) (p < 0.001), and 0 (IQR 0-1+) versus 1+ (IQR 0-1+) (p = 0.004), respectively.

CONCLUSION

In high-risk patients undergoing AVR with grade 3-4+ MR, a transaortic edge-to-edge mitral valve repair may be a safe and effective alternative to conventional double-valve surgery. However, longer-term data are needed to verify this proposal.