Document Detail


Midterm results of edge-to-edge mitral valve repair without annuloplasty.
MedLine Citation:
PMID:  14688717     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Francesco Maisano; Alessandro Caldarola; Andrea Blasio; Michele De Bonis; Giovanni La Canna; Ottavio Alfieri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2003-12-22     Completed Date:  2004-01-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1987-97     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. francesco.maisano@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Calcinosis / 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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