Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation.

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
Export Citation:	APA/MLA Format Download EndNote Download BibTex
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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