Long-term results of suture annuloplasty for degenerative mitral valve disease: A propensity-matched analysis

Andrea Garatti, Alberto Canziani, Alessandro Parolari, Serenella Castelvecchio, Marco Guazzi, Andrea Daprati, Ali Abu Farah, Francesco Grimaldi, Sonia Tripepi, Lorenzo Menicanti

Research output: Contribution to journalArticle

Abstract

Aims Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. Methods From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n=147 (37%)] or with flexible posterior annuloplasty band [n=253 (63%)]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. Results After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P=0.20). In-hospital mortality was comparable between the two study groups (P=0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P=0.71). At a mean follow-up of 11±3 years, all-cause mortality (P=0.12), need for mitral valve replacement (P=0.49), and cardiac re-hospitalization rate (P=0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71%, P=0.51) and freedom from MVF (92 vs. 84%, P=0.39) were similar between posterior annuloplasty band and DSA groups. Conclusion Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in developing countries.

Original languageEnglish
Pages (from-to)22-26
Number of pages5
JournalJournal of Cardiovascular Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Mitral Valve Annuloplasty
Mitral Valve
Sutures
Propensity Score
Suture Techniques
Mitral Valve Insufficiency
Hospital Mortality
Endocarditis
Developing Countries
Echocardiography
Hospitalization
Hemodynamics

Keywords

  • echocardiography
  • mitral valve disease
  • mitral valve repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-term results of suture annuloplasty for degenerative mitral valve disease : A propensity-matched analysis. / Garatti, Andrea; Canziani, Alberto; Parolari, Alessandro; Castelvecchio, Serenella; Guazzi, Marco; Daprati, Andrea; Farah, Ali Abu; Grimaldi, Francesco; Tripepi, Sonia; Menicanti, Lorenzo.

In: Journal of Cardiovascular Medicine, Vol. 19, No. 1, 01.01.2018, p. 22-26.

Research output: Contribution to journalArticle

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abstract = "Aims Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. Methods From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n=147 (37{\%})] or with flexible posterior annuloplasty band [n=253 (63{\%})]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. Results After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P=0.20). In-hospital mortality was comparable between the two study groups (P=0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P=0.71). At a mean follow-up of 11±3 years, all-cause mortality (P=0.12), need for mitral valve replacement (P=0.49), and cardiac re-hospitalization rate (P=0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71{\%}, P=0.51) and freedom from MVF (92 vs. 84{\%}, P=0.39) were similar between posterior annuloplasty band and DSA groups. Conclusion Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in developing countries.",
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T1 - Long-term results of suture annuloplasty for degenerative mitral valve disease

T2 - A propensity-matched analysis

AU - Garatti, Andrea

AU - Canziani, Alberto

AU - Parolari, Alessandro

AU - Castelvecchio, Serenella

AU - Guazzi, Marco

AU - Daprati, Andrea

AU - Farah, Ali Abu

AU - Grimaldi, Francesco

AU - Tripepi, Sonia

AU - Menicanti, Lorenzo

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AB - Aims Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. Methods From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n=147 (37%)] or with flexible posterior annuloplasty band [n=253 (63%)]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. Results After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P=0.20). In-hospital mortality was comparable between the two study groups (P=0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P=0.71). At a mean follow-up of 11±3 years, all-cause mortality (P=0.12), need for mitral valve replacement (P=0.49), and cardiac re-hospitalization rate (P=0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71%, P=0.51) and freedom from MVF (92 vs. 84%, P=0.39) were similar between posterior annuloplasty band and DSA groups. Conclusion Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in developing countries.

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