| Midterm results of edge-to-edge mitral valve repair without annuloplasty. | |
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MedLine Citation:
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PMID: 14688717 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. METHODS: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. RESULTS: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% +/- 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% +/- 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% +/- 22% vs 95% +/- 4.6% freedom from reoperation, P =.03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. CONCLUSIONS: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures. |
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Authors:
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Francesco Maisano; Alessandro Caldarola; Andrea Blasio; Michele De Bonis; Giovanni La Canna; Ottavio Alfieri |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 126 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2003 Dec |
Date Detail:
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Created Date: 2003-12-22 Completed Date: 2004-01-22 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1987-97 Citation Subset: AIM; IM |
Affiliation:
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Cardiac Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. francesco.maisano@hsr.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Calcinosis
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surgery Cardiac Surgical Procedures / methods Echocardiography, Doppler Female Heart Valve Diseases / surgery Humans Male Middle Aged Mitral Valve / surgery*, ultrasonography Proportional Hazards Models Reoperation Retrospective Studies Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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