Document Detail


Edge-to-edge mitral repair without annuloplasty in combination with surgical ventricular restoration.
MedLine Citation:
PMID:  17383331     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Functional mitral regurgitation is common in ischemic dilated cardiomyopathy. Edge-to-edge repair is an option for correction and can be performed through the ventriculotomy during surgical ventricular restoration (SVR). This report describes the durability of the edge-to-edge repair without annuloplasty in combination with SVR. METHODS: From March 1997 to July 2002, 31 patients with left ventricular aneurysm or ischemic dilated cardiomyopathy and functional ischemic mitral regurgitation grade II (n = 18), III (n = 10), and IV (n = 3) underwent SVR and edge-to-edge repair without annuloplasty with concomitant coronary artery bypass grafting. Long-term valve competence was assessed by echocardiography. Early and late survival and hospital readmission for heart failure were analyzed. RESULTS: Early mortality was 5 (16%) of 31 patients. At 1, 3, and 5 years, actuarial survival was 77%, 55%, and 48%. The cumulative follow-up was 117 patient-years (4.5 years mean follow-up). Late echocardiograms performed at a mean of 3.1 years postoperatively showed patients had mitral regurgitation at grade 0 (n = 4), I (n = 10), II (n = 9), and III (n = 1). Two patients underwent reoperation owing to grade III-IV recurrent mitral regurgitation. Freedom from hospital readmission or cardiac death was 56% at 1 year and 48% at 3 years. CONCLUSIONS: Combined mitral valve repair and SVR carries high operative risk and long-term prognosis is worse than after SVR alone. The edge-to-edge repair without annuloplasty for functional ischemic mitral regurgitation seems to be fairly durable in conjunction with SVR. To improve results a transventricular annuloplasty may be added.
Authors:
Ulrik Sartipy; Anders Albåge; Eva Mattsson; Dan Lindblom
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1303-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden. ulrik.sartipy@karolinska.se
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Surgical Procedures / methods*
Cardiomyopathy, Dilated / prevention & control
Combined Modality Therapy
Coronary Artery Bypass / methods
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Ventricles / surgery*
Hospital Mortality
Humans
Male
Middle Aged
Mitral Valve / surgery*
Mitral Valve Insufficiency / mortality*,  surgery*,  ultrasonography
Probability
Retrospective Studies
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Survival Analysis
Treatment Outcome
Ventricular Remodeling / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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