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J Thorac Cardiovasc Surg 1998;115:1279-1283
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 12, 1997. Revisions requested August 22, 1997; revisions received Feb. 13, 1998. Accepted for publication Feb. 13, 1998. Address for reprints: T.E. David, MD, 200 Elizabeth St., 13EN219, Toronto, Ontario, Canada M5G 2C4
Abstract
Objective: This study was carried out to evaluate the long-term results of mitral valve repair for mitral regurgitation caused by myxomatous disease of the mitral valve and the late effects of chordal replacement with expanded polytetrafluoroethylene sutures in this operation.
Methods: A total of 324 patients with mitral regurgitation caused by myxomatous disease underwent mitral valve repair from 1981 to 1995; the group comprised 241 men and 83 women whose mean age was 58 ± 14 years. Chordal replacement with expanded polytetrafluoroethylene sutures has been performed in 165 patients since 1985. Most of the patients who had chordal replacement with expanded polytetrafluoroethylene sutures had prolapse of the anterior leaflet or prolapse of both leaflets, whereas most patients who had mitral valve repair without chordal replacement had prolapse of the posterior leaflet. Patients were followed up at annual intervals and had a Doppler echocardiographic study. The follow-up was complete and extended from 6 to 156 months (mean 36 ± 30 months).
Results: Two operative and 21 late deaths occurred (14 cardiac and 7 noncardiac). At 10 years the actuarial survival was 75% ± 5%, the freedom from stroke was 94% ± 2%, the freedom from transient ischemic attacks was 92% ± 4%, the freedom from endocarditis was 99% ± 1%, the freedom from mitral valve reoperation was 96% ± 1%, and the freedom from severe mitral regurgitation was 93% ± 3%. Chordal replacement with expanded polytetrafluoroethylene sutures had no effect on any of these end points.
Conclusions: Mitral valve repair was feasible in most patients with mitral regurgitation caused by myxomatous disease and it was associated with low rates of valve-related complications. Chordal replacement with expanded polytetrafluoroethylene had no adverse effect on the late outcome and was believed to have increased the probability of mitral valve repair.
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L. F. Duebener, O. Wendler, N. Nikoloudakis, T. Georg, R. Fries, and H.-J. Schafers Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using polytetrafluoroethylene sutures for chordal replacement Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 206 - 212. [Abstract] [Full Text] [PDF]
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T. Matsumoto, H. Kado, M. Masuda, Y. Shiokawa, K. Fukae, S. Morita, and H. Yasui CLINICAL RESULTS OF MITRAL VALVE REPAIR BY RECONSTRUCTING ARTIFICIAL CHORDAE TENDINEAE IN CHILDREN J. Thorac. Cardiovasc. Surg., July 1, 1999; 118(1): 94 - 98. [Abstract] [Full Text] [PDF]
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P. Totaro, E. Tulumello, P. Fellini, M. Rambaldini, G. La Canna, G. Coletti, M. Zogno, and R. Lorusso Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up Eur. J. Cardiothorac. Surg., February 1, 1999; 15(2): 119 - 126. [Abstract] [Full Text] [PDF]
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