Associazione Nazionale Medici Cardiologi Ospedalieri



Long-term Outcome of Mitral Valve Repair with tailor-made Posterior Flexible Band

Olivieri Guido Maria Milano(Milano) – ASST GOM Niguarda | De Chiara Benedetta Carla Milano(Milano) – ASST GOM Niguarda | Settepani Fabrizio Milano(Milano) – ASST GOM Niguarda

Background and Aim

Mitral valve repair commonly involves the fixation of the annulus to restore optimal diameters. In specific features (normal LV and annulus dimensions), the implementation of posterior rings reduce recurrent MR, avoiding possible systolic anterior motion development. Aim of our study was to evaluate the long-term outcome of patients undergoing mitral repair with a tailor-made posterior band.


Retrospective and prospective single centre analysis. Inclusion criteria: age > 18 years; mitral valve repair with posterior leaflet resection and implantation of posterior flexible band; surgery from 2003 to 2021. End-points: freedom from mitral valve re-operation, freedom from recurrence of mitral regurgitation grade > II and overall survival at follow-up. Data obtained from regional database, clinical outpatient assessments and phone calls. Institutional ethical committee board approval.


289 patients, 109 females (37.7%), were included. Median age was 64 years (IQR 56-71). Sternotomy was the preferred surgical approach (225 pts, 77.8%) while 64 patients underwent mini-thoracotomy (22.1%). 74 (25.6%) patients required combined procedures: CABG, PFO closure and LAA exclusion were the most popular with 21, 20, and 18 cases respectively (6.3, 6 and 5.4%). In-hospital mortality was 0.01% (3 patients). Major post-operative complications (AKI, prolonged ventilation, major injection, severe bleeding, stroke) occurred in less than 5% of the patients. Median follow-up is 11.1 years (IQR 4.7-15.2). Freedom from re-operation is 98.6±0.7%, 97.3.±1.2% and 77.7±8.5% after 1, 10 and 18 years, respectively. Freedom from recurrence of MR grade > II is 98.5.±0.7%, 95.7.±1.5% and 83.8±4.6% at 1, 10 and 18 years, respectively. Overall survival at follow-up is 97.5±0.9%, 83.1.±2.7% and 55.6±8.7% at 1, 10 and 18 years, respectively.


In our experience mitral valve repair with tailor-made posterior flexible band is a safe and reproducible surgical technique, both isolated or as a combined procedure. Outcomes are positive and encouraging with a satisfactory low rate of re-operation and recurrent mitral regurgitation grade II or more at long-term follow-up. Data of a larger population are required to confirm the positive results of our single centre study.