| Mitral valve replacement in rheumatic patients: effects of chordal preservation. | |
| | |
MedLine Citation:
|
PMID: 18640319 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Subvalvular preservation is beneficial in patients undergoing mitral valve replacement, especially in degenerative mitral regurgitation. Its feasibility and benefit is less evident in rheumatic disease. Our aim was to study the impact of preservation techniques in rheumatic patients and determine risk factors for mortality. METHODS: Five hundred sixty-six rheumatic patients undergoing mitral valve replacement between 1996 and 2006 have been included. One hundred fifty-six patients had complete excision of the subvalvular apparatus (group 1), 248 had preservation of the posterior leaflet (group 2), and 162 had total chordal preservation (group 3). Echocardiography was performed preoperatively, at discharge, at 1 year, and at late follow-up. RESULTS: Reduction of ventricular volume was greater in groups 2 and 3, especially if previous mitral regurgitation or mixed disease were present. In mitral stenosis, valve resection caused postoperative increase of volume. Ventricular ejection and pulmonary hypertension had better outcome with valve preservation. Valve resection was associated with late mortality (hazard ratio, 2.64; p < 0.05), and complete chordal preservation was protective (hazard ratio, 0.31; p = 0.13). Actuarial survival (130 months) was better in group 3: 77.18% +/- 0.04%, 85.38% +/- 0.03%, and 93.22% +/- 0.02%, respectively (p < 0.01 group 1 versus group 3). Group 1 exhibited more low cardiac output syndrome (p < 0.01) and more patients in New York Heart Association functional class III and IV at last follow-up: 17.8% versus 3.9% and 2.0% (p < 0.001). CONCLUSIONS: Complete chordal preservation is possible in a large percentage of rheumatic patients. Greater decrease of ventricular volume is obtained for mitral regurgitation. In mitral stenosis, subvalvular preservation may avoid postoperative ventricular dilatation. Consequently, ventricular ejection, pulmonary hypertension, and clinical outcomes may improve with time. |
| | |
Authors:
|
Rafael García-Fuster; Vanessa Estevez; Oscar Gil; Sergio Cánovas; Juan Martínez-Leon |
Related Documents
:
|
8439829 - Effect of ageing on the relationship between early diastolic left ventricular function ... 7344589 - Surgical management of rheumatic heart disease in singapore. 11930339 - Differential diagnosis of infective endocarditis. 7337059 - Echocardiography in elderly patients with systolic murmurs. 18928489 - The transseptal t-cut--what more can we see? 17060039 - Unusually large left atrial myxoma causing mitral valve occlusion and hiding a severe m... 15184349 - Effect of irbesartan versus atenolol on left ventricular mass and voltage: results of t... 21885799 - Temporal pattern of left ventricular structural and functional remodeling following rev... 22112779 - Irradiation induced modest changes in murine cardiac function despite progressive struc... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Annals of thoracic surgery Volume: 86 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2008 Aug |
Date Detail:
|
Created Date: 2008-07-21 Completed Date: 2008-09-03 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
|
Languages: eng Pagination: 472-81; discussion 481 Citation Subset: AIM; IM |
Affiliation:
|
Department of Cardiac Surgery, University General Hospital of Valencia, Valencia, Spain. rgfuster@terra.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Female Heart Valve Prosthesis Implantation / methods* Hospital Mortality Humans Male Middle Aged Mitral Valve / surgery* Multivariate Analysis Postoperative Complications / epidemiology Retrospective Studies Rheumatic Heart Disease / mortality, physiopathology, surgery* Risk Factors Suture Techniques |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Left thoracotomy for multiple-time redo mitral valve surgery using on-pump beating heart technique.
Next Document: The Ross procedure in adults: long-term follow-up and echocardiographic changes leading to pulmonary...