Autologous pericardium annuloplasty

A "physiological" mitral valve repair

L. Salvador, E. Cavarretta, G. Minniti, E. Di Angelantonio, V. Salandin, G. Frati, E. Polesel, C. Valfrè

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim: Autologous pericardium annuloplasty (APA) is an alternative to prosthetic ring implantation for mitral valve (MV) repair, avoiding the use of foreign material and preserving the mitral annulus' physiological motion. However, data on durability are questionable. Therefore, we analyzed long-term outcomes of treating degenerative mitral regurgitation (MR) with APA. Methods: Four hundred ninety patients (mean age, 54.3±11.3 years, [15-77 years]; N.=360 men [74.1%]) who had undergone APA and neochordae implantation between July 1988 and December 2006 were retrospectively studied. Results: MR was purely degenerative in 434 (89-3%) patients; endocarditis 'was present in 44 (9-1%) patients; an anterior, posterior, or bileaflet prolapse was present in 32 (6.6%), 241 (49.6%), and 213 (43.8%) patients, respectively. Clinical follow-up was 100% complete at a median of 6.5 years (5th percentile, 0.9; 95th percentile, 14.9) with an echocardiographic study in 92% of patients. In-hospital mortality was 1% (5 deaths); overall and late cardiac mortality were 7.6% and 3.9% (37 and 19 deaths), respectively. Kaplan-Meier curves for overall survival, late cardiac survival, and freedom from reoperation at 15 years (20 cases) were 86% (95%CI 80-91), 93% (95%CI 88-96), and 93% (95%CI 88-96), respectively. At 15 years, freedom from recurrent MR (28 patients) and. endocarditis (6 events) were 86% (95%CI 76-91) and 97% (95%CI 92-99). Dehiscence, significant calcification of APA, and hemolysis never occurred. At reoperations, annular pericardium appeared covered by a smooth layer of tissue. Conclusion: APA is feasible, safe, and cost-effective, providing long-term durability, high survival, and a low rate of valve-related complications.

Original languageEnglish
Pages (from-to)831-839
Number of pages9
JournalJournal of Cardiovascular Surgery
Volume55
Issue number6
Publication statusPublished - Dec 1 2014

Fingerprint

Pericardium
Mitral Valve
Mitral Valve Insufficiency
Endocarditis
Reoperation
Survival
Prolapse
Kaplan-Meier Estimate
Hospital Mortality
Hemolysis
Costs and Cost Analysis
Mortality

Keywords

  • Mitral valve anuloplasty
  • Mitral valve insufficiency
  • Mitral valve prolapse

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

Salvador, L., Cavarretta, E., Minniti, G., Di Angelantonio, E., Salandin, V., Frati, G., ... Valfrè, C. (2014). Autologous pericardium annuloplasty: A "physiological" mitral valve repair. Journal of Cardiovascular Surgery, 55(6), 831-839.

Autologous pericardium annuloplasty : A "physiological" mitral valve repair. / Salvador, L.; Cavarretta, E.; Minniti, G.; Di Angelantonio, E.; Salandin, V.; Frati, G.; Polesel, E.; Valfrè, C.

In: Journal of Cardiovascular Surgery, Vol. 55, No. 6, 01.12.2014, p. 831-839.

Research output: Contribution to journalArticle

Salvador, L, Cavarretta, E, Minniti, G, Di Angelantonio, E, Salandin, V, Frati, G, Polesel, E & Valfrè, C 2014, 'Autologous pericardium annuloplasty: A "physiological" mitral valve repair', Journal of Cardiovascular Surgery, vol. 55, no. 6, pp. 831-839.
Salvador L, Cavarretta E, Minniti G, Di Angelantonio E, Salandin V, Frati G et al. Autologous pericardium annuloplasty: A "physiological" mitral valve repair. Journal of Cardiovascular Surgery. 2014 Dec 1;55(6):831-839.
Salvador, L. ; Cavarretta, E. ; Minniti, G. ; Di Angelantonio, E. ; Salandin, V. ; Frati, G. ; Polesel, E. ; Valfrè, C. / Autologous pericardium annuloplasty : A "physiological" mitral valve repair. In: Journal of Cardiovascular Surgery. 2014 ; Vol. 55, No. 6. pp. 831-839.
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T2 - A "physiological" mitral valve repair

AU - Salvador, L.

AU - Cavarretta, E.

AU - Minniti, G.

AU - Di Angelantonio, E.

AU - Salandin, V.

AU - Frati, G.

AU - Polesel, E.

AU - Valfrè, C.

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N2 - Aim: Autologous pericardium annuloplasty (APA) is an alternative to prosthetic ring implantation for mitral valve (MV) repair, avoiding the use of foreign material and preserving the mitral annulus' physiological motion. However, data on durability are questionable. Therefore, we analyzed long-term outcomes of treating degenerative mitral regurgitation (MR) with APA. Methods: Four hundred ninety patients (mean age, 54.3±11.3 years, [15-77 years]; N.=360 men [74.1%]) who had undergone APA and neochordae implantation between July 1988 and December 2006 were retrospectively studied. Results: MR was purely degenerative in 434 (89-3%) patients; endocarditis 'was present in 44 (9-1%) patients; an anterior, posterior, or bileaflet prolapse was present in 32 (6.6%), 241 (49.6%), and 213 (43.8%) patients, respectively. Clinical follow-up was 100% complete at a median of 6.5 years (5th percentile, 0.9; 95th percentile, 14.9) with an echocardiographic study in 92% of patients. In-hospital mortality was 1% (5 deaths); overall and late cardiac mortality were 7.6% and 3.9% (37 and 19 deaths), respectively. Kaplan-Meier curves for overall survival, late cardiac survival, and freedom from reoperation at 15 years (20 cases) were 86% (95%CI 80-91), 93% (95%CI 88-96), and 93% (95%CI 88-96), respectively. At 15 years, freedom from recurrent MR (28 patients) and. endocarditis (6 events) were 86% (95%CI 76-91) and 97% (95%CI 92-99). Dehiscence, significant calcification of APA, and hemolysis never occurred. At reoperations, annular pericardium appeared covered by a smooth layer of tissue. Conclusion: APA is feasible, safe, and cost-effective, providing long-term durability, high survival, and a low rate of valve-related complications.

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KW - Mitral valve anuloplasty

KW - Mitral valve insufficiency

KW - Mitral valve prolapse

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