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The Journal of Thoracic and Cardiovascular Surgery, Vol 116, 734-743, Copyright © 1998 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AM Gillinov, DM Cosgrove, EH Blackstone, R Diaz, JH Arnold, BW Lytle, NG Smedira, JF Sabik, PM McCarthy and FD Loop
BACKGROUND: Degenerative mitral valve disease is the most common cause of
mitral regurgitation in the United States. Mitral valve repair is
applicable in the majority of these patients and has become the procedure
of choice. OBJECTIVE: This study was undertaken to identify factors
influencing the durability of mitral valve repair. PATIENTS AND METHODS:
Between 1985 and 1997, 1072 patients underwent primary isolated mitral
valve repair for valvular regurgitation caused by degenerative disease.
Repair durability was assessed by multivariable risk factor analysis of
reoperation. It was supplemented by a search for valve-related risk factors
for death before reoperation. Three hospital deaths occurred (0.3%);
complete follow-up (4152 patient- years) was available in 1062 of 1069
hospital survivors (99.3%). RESULTS: At 10 years, freedom from reoperation
was 93%. Among 30 patients who required reoperation for late mitral valve
dysfunction, the repair failed in 16 (53%) as a result of progressive
degenerative disease. Durability of repair was adversely affected by
pathologic conditions other than posterior leaflet prolapse, use of chordal
shortening, annuloplasty alone, and posterior leaflet resection without
annuloplasty. Durability was greatest after quadrangular resection and
annuloplasty for posterior leaflet prolapse and was enhanced by the use of
intraoperative echocardiography. Death before reoperation was increased in
patients having isolated anterior leaflet prolapse or valvular
calcification and by use of chordal shortening or annuloplasty alone.
CONCLUSIONS: Repair durability is greatest in patients with isolated
posterior leaflet prolapse who have posterior leaflet resection and
annuloplasty. Chordal shortening, annuloplasty alone, and leaflet resection
without annuloplasty jeopardize late results.
ARTICLES
Durability of mitral valve repair for degenerative disease
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
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