Document Detail


Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation.
MedLine Citation:
PMID:  22929220     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The very long-term results of the double-orifice mitral valve repair are unknown. The aim of this study was to assess the late clinical and echocardiographic outcomes of this technique in patients with degenerative mitral regurgitation.
METHODS: From 1993 to 2000, 174 patients with severe degenerative mitral regurgitation were treated with the double-orifice technique combined with ring annuloplasty. Mean age of patients was 52 ± 12.8 years, New York Heart Association class I or II was present in 71% of the patients, atrial fibrillation in 17.2%, and preoperative left ventricular ejection fraction was 59.5% ± 7.5%. Mitral regurgitation was due to anterior leaflet prolapse in 36 patients (20.6%), bileaflet prolapse in 128 (73.5%), and posterior leaflet prolapse in 10 patients (5.7%).
RESULTS: There were no hospital deaths. At hospital discharge, mitral regurgitation was absent or mild in 169 patients (97.1%) and moderate (2+/4+) in 5 patients (2.8%). Mitral stenosis requiring reoperation was detected in 1 patient (0.6%). Clinical and echocardiographic follow-up was 97.1% complete (mean length, 11.5 ± 2.53 years; median, 11.6 years; longest duration, 17.6 years). At 14 years, actuarial survival was 86.9% ± 3.37%, freedom from cardiac death was 95.8% ± 1.54%, and freedom from reoperation was 89.6 ± 2.51%. At the last echocardiographic examination, recurrence of mitral regurgitation ≥3+ was documented in 23 patients (23/169, 13.6%). Freedom from mitral regurgitation ≥3+ at 14 years was 83.8% ± 3.39%. The only predictor of recurrence of mitral regurgitation ≥3+ was residual mitral regurgitation greater than mild at hospital discharge (hazard ratio, 5.7; 95% confidence interval, 1.6-20.6; P = .007).
CONCLUSIONS: The double-orifice repair combined with ring annuloplasty provides very satisfactory long-term results in patients with degenerative mitral regurgitation in the setting of bileaflet and anterior leaflet prolapse.
Authors:
Michele De Bonis; Elisabetta Lapenna; Roberto Lorusso; Nicola Buzzatti; Nicola Buzzati; Sandro Gelsomino; Maurizio Taramasso; Enrico Vizzardi; Ottavio Alfieri
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-08-25
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  144     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-19     Completed Date:  2013-01-10     Revised Date:  2013-02-25    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1019-24     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. michele.debonis@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chi-Square Distribution
Female
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Humans
Italy
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve Annuloplasty* / adverse effects,  mortality
Mitral Valve Insufficiency / etiology,  mortality,  surgery*,  ultrasonography
Mitral Valve Prolapse / complications,  mortality,  surgery*,  ultrasonography
Mitral Valve Stenosis / etiology,  surgery
Proportional Hazards Models
Recurrence
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2013 Jan;145(1):316   [PMID:  23244272 ]
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1024-6   [PMID:  22929219 ]
J Thorac Cardiovasc Surg. 2013 Jan;145(1):315-6   [PMID:  23244271 ]
Erratum In:
J Thorac Cardiovasc Surg. 2013 Feb;145(2):617
Note: Buzzati, Nicola [corrected to Buzzatti, Nicola]

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