Evaluation of Early and Midterm Mitral Valve Repair Results in Consecutive Severe Mitral Regurgitation Patients

Feragat Uygur; Hayati Deniz

doi:10.23751/pn.v24iS1.12879

Evaluation of Early and Midterm Mitral Valve Repair Results in Consecutive Severe Mitral Regurgitation Patients

Authors

Feragat Uygur Sanko University, Faculty of Medicine, Education and Research Hospital, Department of Cardiovascular Surgery Gaziantep,Turkey
Hayati Deniz Gaziantep Dr Ersin Arsan Traning and Research Hospital

Keywords:

Mitral Valve Repair, Regurgitation, Repair Techniques

Abstract

Study Objectives: Surgical valve repair for mitral regurgitation has significant advantages over valve replacement. In this study, we aimed to investigate the early and mid-term results of mitral valve repair using current techniques in order to find out independent risk factors affecting the early and mid-term outcomes. Methods: We retrospectively studied firstly 192 consecutive adult patients (mean age: 43.2±12.3; 120 females and 72 males) who underwent primary mitral valve repair between January 2012 and July 2018. Risk factors affecting the need for re-operations and late survival were determined via univariate and multivariate analyses. Actuarial survival and event-free curves were compared by linear regression analysis. Results: Operative mortality was 2.6% (5 deaths 0–30th. postoperative day (POD). Late mortality was 3.7% (7/187). Reoperation was required in 16 (8.3%) patients. Kaplan–Meier actuarial survival was 95.8%±2.3% at a mean of 43 months. Survival free from reoperation was 92.8%± 4.2% at 60 months. Multivariate analysis demonstrated that residual NYHA class III and IV, low preoperative ejection fraction, and ischemic MR were independent predictors of mortality. Conclusion: We concluded that mitral valve repair showed excellent survival (except ischemic MR), acceptable re-operation rate with satisfactory valve function in a mid-term follow-up period.

References

-Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 2001;104(Suppl 1):I-8-11

-Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-43

-Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AL, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation 1995;91:1022-8

-Suri RM, Schaff HV, Dearrani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82:819-26

-Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 2001;122:1125-41

-Vetter HO, Burack JH, Factor SM, et al. Replacement of chordae tendineae of the mitral valve using the new expanded PTFE suture in sheep. In: Bodnar E, Yacoub M, eds. Biologic bioprosthetic valves. New York:Yorke Medical Books, 1986:772-84.

-Seeburger J, Kuntze T, Mohr FW. Gore-Tex chordoplasty in degenerative mitral valve repair. Semin Thorac Cardiovasc Surg 2007;19:111-8.

-Savage EB, Ferguson TB Jr, DiSesa VJ. Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg 2003;75:820-5

-Gogbashian A, Sepic J, Soltesz EG, Nascimben L, Cohn LH. Operative and long-term survival of elderly is significantly improved by mitral valve repair. Am Heart J 2006;151:1325-33

- Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81

-Ailwadi G, Swenson BR, Girotti ME, et al. Is mitral valve repair superior to replacement in elderly patients? Ann Thorac Surg 2008;86:77-86

- Gilinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg 2008;135:885-93.

-Habib G, Thuny F, Avierinos JF. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis 2008;50:274-81

-Gazoni LM, Kern JA, Swenson BR, et al. A change in perspective: results for ischemic mitral valve repair are similar to mitral valve repair for degenerative disease. Ann Thorac Surg 2007;84:750-7

-Thourani VH, Weintraub WS, Guyton RA, et al. Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. Circulation 2003;108:298-304

- Nagendran J, Norris C, Maitland A, Koshal A, Ross DB. Is mitral valve surgery safe in ocrogenarians? Eur J Cardiothorac Surg 2005;28:83-7

-Deloche A, Jebara VA, Relland JYM, et al. Valve repair with Carpentier techniques. The second decade. J Thorac Cardiovasc Surg 1990; 99: 990-1002.

-Lessana A, Viet TT, Ades F, et al. Mitral reconstructive operations. A series of 130 consecutive cases. J Thorac Cardiovasc Surg 1983; 86: 553-61

-Cosgrove DM 3rd, Arcidi JM, Rodriquez L, Stewart WJ, Powell K, Thomas JD. Initial experience with the Cosgrove-Edwards Annuloplasty System Ann Thorac Cardiovasc Surg 1995;60:499-504

-Gillinov AM, Cosgrove DM, Lytle BW, et al. Reoperation for failure of mitral valve repair. J Thorac Cardiovasc Surg 1997; 113: 467-75.

-Orszulak TA, Schaff HV, Danielson GK, et al. Mitral regurgitation due to ruptured chordae tendineae. Early and late results of valve repair. J Thorac Cardiovasc Surg 1985; 89: 491-8.

-Schravone WA, Cosgrove DM, Lever HM, Stewart WJ, Salcedo EE. Long-term follow-up of patients with left ventricular outflow tract obstruction after Carpentier ring mitral valvuloplasty. Circulation 1988;78:160-5