Improved results with mitral valve repair using new surgicaltechniques

C. Fucci, L. Sandrelli, A. Pardini, L. Torracca, M. Ferrari, O. Alfieri

Research output: Contribution to journalArticlepeer-review

Abstract

From January 1987 to July 1994, 299 consecutive patients ranging from 4to 80 years of age underwent mitral repair for pure valve insufficiency dueto degenerative disease (59%), rheumatic disease (23%), endocarditis (12%)or ischemic heart disease (6%). During the initial period, a variety ofreparative methods were used following the principles originally describedby Carpentier. More recently, in our institution other surgical techniqueshave been introduced: specifically, prolapse of the anterior leaflet wascorrected either by replacing the chordae with polytetrafluoroethylene(PTFE) sutures or simply by anchoring the prolapsing free edge to thefacing edge of the posterior leaflet ("edge-to-edge" technique). Chordaltransposition has also been used occasionally to correct the prolapse ofthe anterior leaflet. The hospital mortality rate was 1.3%. According toactuarial methods, the overall survival rate was 94% at 7 years, andfreedom from reoperation was 86%. Significant incremental risk factors forreoperation were: no use of prosthetic ring, correction of the prolapse ofthe anterior leaflet by triangular resection or chordal shortening andischemic etiology of the mitral insufficiency (freedom from reoperation at7 years was 61%, 56% and 51%, respectively). In the late postoperativeperiod (mean follow-up 3.6 years), 95% of the patients were in NYHA class Ior II; four patients had thromboembolic episodes, two hemorrhagiccomplications and two endocarditis. No patient in whom the prolapse of theanterior leaflet was corrected by the recently introduced technique hasrequired reoperation. The anterior mitral leaflet prolapse was thereforeneutralized as an incremental risk factor for reoperation and this hascontributed to the improved overall results of mitral valve repair.

Original languageEnglish
Pages (from-to)621-626
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume9
Issue number11
DOIs
Publication statusPublished - 1995

Keywords

  • Mitral repair
  • Mitral valve
  • Reconstructive surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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