TY - JOUR
T1 - Can the edge-to-edge technique provide durable results when used to rescue patients with suboptimal conventional mitral repair?
AU - De Bonis, Michele
AU - Lapenna, Elisabetta
AU - Buzzatti, Nicola
AU - Taramasso, Maurizio
AU - Calabrese, Maria Chiara
AU - Nisi, Teodora
AU - Pappalardo, Federico
AU - Alfieri, Ottavio
PY - 2013/6
Y1 - 2013/6
N2 - Objectives: The 'edge-to-edge' technique (EE) can be used as a bailout procedure in case of a suboptimal result of conventional mitral valve (MV) repair. The aim of this study was to assess the long-term outcomes of this technique used as a rescue procedure. Methods: From 1998 to 2011, of 3861 patients submitted to conventional MV repair for pure mitral regurgitation (MR), 43 (1.1%) underwent a rescue edge-to-edge repair for significant residual MR at the intraoperative hydrodynamic test or at the intraoperative transoesophageal echocardiography. Residual MR was due to residual prolapse in 30 (69.7%) patients, systolic anterior motion in 12 (27.9%) and post-endocarditis leaflet erosion in 1 (2.3%). According to the location of the regurgitant jet, the edge-to-edge suture was performed centrally (60.5%) or in correspondence with the anterior or posterior commissure (39.5%). The original repair was left in place. Results: There were no hospital deaths. Additional cross-clamp time was 15.2 ± 5.6 min. At hospital discharge, all patients showed no or mild MR and no mitral stenosis. Clinical and echocardiographic follow-up was 97.6% complete (median length 5.7 years, up to 14.6 years). At 10 years, actuarial survival was 89 ± 7.4% and freedom from cardiac death 100%. Freedom from reoperation and freedom from MR ≥3+ at 10 years were both 96.9 ± 2.9%. At the last echocardiogram, MR was absent or mild in 37 patients (88%), moderate in 4 (9.5%) and severe in 1 (2.4%). No predictors for recurrence of MR ≥2+ were identified. The mean MV area and gradient were 2.8 ± 0.6 cm2 and 2.7 ± 0.9 mmHg. NYHA I-II was documented in all cases. Conclusions: A 'rescue' EE can be a rapid and effective option in case of suboptimal result of 'conventional' MV repair. Long-term durability of the repair is not compromised.
AB - Objectives: The 'edge-to-edge' technique (EE) can be used as a bailout procedure in case of a suboptimal result of conventional mitral valve (MV) repair. The aim of this study was to assess the long-term outcomes of this technique used as a rescue procedure. Methods: From 1998 to 2011, of 3861 patients submitted to conventional MV repair for pure mitral regurgitation (MR), 43 (1.1%) underwent a rescue edge-to-edge repair for significant residual MR at the intraoperative hydrodynamic test or at the intraoperative transoesophageal echocardiography. Residual MR was due to residual prolapse in 30 (69.7%) patients, systolic anterior motion in 12 (27.9%) and post-endocarditis leaflet erosion in 1 (2.3%). According to the location of the regurgitant jet, the edge-to-edge suture was performed centrally (60.5%) or in correspondence with the anterior or posterior commissure (39.5%). The original repair was left in place. Results: There were no hospital deaths. Additional cross-clamp time was 15.2 ± 5.6 min. At hospital discharge, all patients showed no or mild MR and no mitral stenosis. Clinical and echocardiographic follow-up was 97.6% complete (median length 5.7 years, up to 14.6 years). At 10 years, actuarial survival was 89 ± 7.4% and freedom from cardiac death 100%. Freedom from reoperation and freedom from MR ≥3+ at 10 years were both 96.9 ± 2.9%. At the last echocardiogram, MR was absent or mild in 37 patients (88%), moderate in 4 (9.5%) and severe in 1 (2.4%). No predictors for recurrence of MR ≥2+ were identified. The mean MV area and gradient were 2.8 ± 0.6 cm2 and 2.7 ± 0.9 mmHg. NYHA I-II was documented in all cases. Conclusions: A 'rescue' EE can be a rapid and effective option in case of suboptimal result of 'conventional' MV repair. Long-term durability of the repair is not compromised.
KW - Edge-to-edge technique
KW - Mitral regurgitation
KW - Mitral valve repair
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U2 - 10.1093/ejcts/ezt056
DO - 10.1093/ejcts/ezt056
M3 - Article
C2 - 23407157
AN - SCOPUS:84878167602
VL - 43
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 6
M1 - ezt056
ER -