Document Detail

Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty.
MedLine Citation:
PMID:  20404254     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We examined predictors of early and very long-term outcome after combined mitral and tricuspid valve repair for rheumatic disease. METHODS AND RESULTS: Between 1974 and 2002, 153 consecutive patients (mean age, 46.0+/-13.2 years) underwent combined mitral and tricuspid valve repair for rheumatic disease. Mitral disease was predominantly stenosis (82.3%); 100% of patients had organic tricuspid valve disease, predominantly with regurgitation (53.6%) or some degree of tricuspid stenosis (46.4%). Mitral repair included commissurotomy in 132 patients (86.3%) associated with a flexible annuloplasty in 108. Tricuspid valve repair included flexible annuloplasty in 68 patients (44.4%) and suture annuloplasty in 20 patients (13.1%) combined with tricuspid commissurotomy in 62 patients (42.5%). Thirty-day mortality was 5.9%. Late mortality was 60.1%. The median follow-up was 15.8 years (interquartile range, 6 to 19 years). Follow-up was 97.9% complete. Age>65 years was the only predictor of late mortality. Kaplan-Meier survival probability was 74.4% at 10 years and 57.0% at 15 years. Sixty-three patients required valve reoperation (mitral valve, 59; tricuspid valve, 38). Predictors of valve reoperations were either mitral or tricuspid commissurotomy without associated prosthetic ring annuloplasty. At 20 years, Kaplan-Meier freedom from reoperation was 48.5+/-5.1%. CONCLUSIONS: Combined mitral and tricuspid valve repair in rheumatic disease showed satisfactory early results. Long-term results were poor because of high mortality and a high number of valve-related reoperations. The use of prosthetic ring annuloplasty was significantly associated with a reduced incidence of both mitral and tricuspid valve reoperations.
Jos? M Bernal; Alejandro Pont?n; Bego?a Diaz; Javier Llorca; Iv?n Garc?a; J Aurelio Sarralde; Jes?s Guti?rrez-Morlote; Carolina P?rez-Negueruela; Jos? M Revuelta
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Publication Detail:
Type:  Journal Article     Date:  2010-04-19
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-04     Completed Date:  2010-05-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1934-40     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, and Universidad de Cantabria, E-39008 Santander, Spain.
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MeSH Terms
Aged, 80 and over
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / instrumentation,  methods,  mortality
Kaplan-Meiers Estimate
Middle Aged
Mitral Valve Insufficiency / mortality*,  surgery*
Multivariate Analysis
Postoperative Complications / mortality
Predictive Value of Tests
Reoperation / statistics & numerical data
Retrospective Studies
Rheumatic Heart Disease / mortality*,  surgery*
Tricuspid Valve Insufficiency / mortality*,  surgery*
Young Adult

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