(P186) EDGE-TO-EDGE TECHNIQUE WITH PARTIAL BAND FOR MITRAL VALVE REPAIR COMPARED TO MITRAL REPLACEMENT FOR ISCHEMIC MITRAL REGURGITATION

Background: Optimal management for ischemic mitral regurgitation (IMR) is controversial. Current evidence supports replacement over repair due to improved durability however the latter often involves undersizing with a complete ring and does not include edge-to-edge approximation.

METHODS AND RESULTS: This is a single-center retrospective study of patients undergoing mitral surgery at the time of revascularization for moderate to severe (3+) or greater IMR between 2004-2020, with either mitral valve replacement (MVR), mitral valve repair with edge-to-edge approximation and mild-undersized annuloplasty (MVr) or undersized ring annuloplasty alone (URA). Freedom from all-cause mortality was analyzed using Cox proportional hazards and recurrence of MR and reoperation were analyzed as cumulative incidence with death as a competing risk. Follow-up echos were assessed for changes in ejection fraction (EF) and LV size using a mixed model. There were 121, 93, and 98 patients in the MVR, MVr and URA groups respectively. Follow-up was significantly longer in the MVr group (5.9 years) compared to the MVR (2.7 years) and URA (3.7 years) groups (p=0.0001). Survival was significantly better after MVr than after MVR (p=0.021) or URA (p=0.003) (94.5% (95%CI [87.3,97.7]) vs 86.6% (95% CI[78.7,91.7]) and 88.7% (95% CI [78.7,94.2]) at 2 years respectively). Rate of recurrent moderate (2-3+) or greater MR was similar between MVr and MVR group (p=0.726) but significantly higher after URA (p= 0 < 0.0001) at latest follow up. There was no difference in the rate of reoperation amongst the groups.

Conclusion: Alfieri repair in addition to mild-undersizing annuloplasty with an incomplete band offers similar durability as compared to replacement and may confer a survival advantage.