¹Faculty of Medicine, University of Iceland, Departments of ³Cardiothoracic Surgery and Anesthesia and ²Intensive Care, ⁴Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.

Key words: Mitral valve repair, mitral valve plasticity, degenerative mitral valve disease, outcome, complications, survival.

doi 10.17992/lbl.2021.06.639

Objectives: Degenerative mitral valve disease is the most common indication for mitral valve repair in the Western world. The aim of this study was to study the long term outcome of mitral valve repair for degenerative mitral valve regurgitation in Iceland.

Material and methods: A retrospective study of 101 consecutive mitral valve repair patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and cerebrovascular event) free survival was estimated using the Kaplan-Meier method and compared to age and gender matched reference population. Median follow-up time was 83 months.

Results: On average there were 6,7 (range 1-14) mitral valve repairs performed annually with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection of the posterior leaflet and 64.4% recieved Gore-Tex^®-chordae. Major early complications occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of intensive care unit stay was one day and the median hospital length of stay was 8 days. One patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCE-free survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was not different from an age and gender matched reference population (p=0.135, log-rank test).

Conclusion: Outcomes of mitral valve repair due to degenerative mitral regurgitation is good in Iceland and results are comparable to larger institutions overseas. Long term prognosis is generally good although early postoperative complications often occur.