Is commissural closure associated with mitral annuloplasty a durable technique for the treatment of mitral regurgitation? A long-term (≤15 years) clinical and echocardiographic study.

Objective: Mitral regurgitation (MR) due to commissural prolapse/flail can be corrected by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The long-term results of this type of repair are unknown. Our aim was to assess the clinical and echocardiographic outcomes of this technique up to 15 years after surgery. Methods: From 1997 to 2007, 125 patients (age, 56.8 +/- 15.7 years; left ventricular ejection fraction, 58.1% +/- 7.1%) with MR due to pure commissural prolapse/flail of 1 or both leaflets underwent commissural closure combined with annuloplasty. The etiology of the disease was degenerative in 88.8% and endocarditis in 11.2%. The commissural region involved was posteromedial in 96 patients (76.8%) and anterolateral in 29 (23.2%). Results: Hospital mortality was 1.6%. At discharge, MR was absent or mild in 120 patients (97.5%) and moderate (2+/4+) in 3 (2.4%). Clinical and echocardiographic follow-up was 98.4% complete (mean length, 7.1 +/- 3.0 years; median, 6.7; longest follow-up, 15). At 11 years, the actuarial survival, freedom from cardiac death, and freedom from reoperation was 78.8% +/- 6.2%, 95.2% +/- 3.3%, and 97.4% +/- 1.4%, respectively. At the last echocardiographic examination, MR 3+ or greater was demonstrated in 4 patients (3.3%). Freedom from MR 3+ or greater at 11 years was 96.3% +/- 1.7%. No predictors for recurrence of MR 3+ or greater were identified. The mean mitral valve area and gradient was 2.9 +/- 0.4 cm(2) and 3.4 +/- 1.1 mm Hg, respectively. New York Heart Association class I to II was documented in all cases. Conclusions: Commissural closure repair combined with annuloplasty provides excellent clinical and echocardiographic long-term results in patients with MR due to commissural lesions.