Midterm results of edge-to-edge mitral valve repair without annuloplasty

Francesco Maisano, Alessandro Caldarola, Andrea Blasio, Michele De Bonis, Giovanni La Canna, Ottavio Alfieri, W. Randolph Chitwood, Christophe Acar, David H. Adams, Robert A. Dion

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Objective: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. Methods: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. Results: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% ± 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% ± 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% ± 22% vs 95% ± 4.6% freedom from reoperation, P = .03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. Conclusions: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.

Original languageEnglish
Pages (from-to)1987-1997
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume126
Issue number6
DOIs
Publication statusPublished - Dec 2003

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Mitral Valve
Reoperation
Transesophageal Echocardiography
Rheumatic Diseases
Catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Midterm results of edge-to-edge mitral valve repair without annuloplasty. / Maisano, Francesco; Caldarola, Alessandro; Blasio, Andrea; De Bonis, Michele; La Canna, Giovanni; Alfieri, Ottavio; Chitwood, W. Randolph; Acar, Christophe; Adams, David H.; Dion, Robert A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 126, No. 6, 12.2003, p. 1987-1997.

Research output: Contribution to journalArticle

Maisano, Francesco ; Caldarola, Alessandro ; Blasio, Andrea ; De Bonis, Michele ; La Canna, Giovanni ; Alfieri, Ottavio ; Chitwood, W. Randolph ; Acar, Christophe ; Adams, David H. ; Dion, Robert A. / Midterm results of edge-to-edge mitral valve repair without annuloplasty. In: Journal of Thoracic and Cardiovascular Surgery. 2003 ; Vol. 126, No. 6. pp. 1987-1997.
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abstract = "Objective: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. Methods: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. Results: There were 3 hospital and 4 late deaths, for a 4-year survival of 85{\%} ± 6.7{\%}. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89{\%} ± 3.9{\%} overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77{\%} ± 22{\%} vs 95{\%} ± 4.6{\%} freedom from reoperation, P = .03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. Conclusions: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.",
author = "Francesco Maisano and Alessandro Caldarola and Andrea Blasio and {De Bonis}, Michele and {La Canna}, Giovanni and Ottavio Alfieri and Chitwood, {W. Randolph} and Christophe Acar and Adams, {David H.} and Dion, {Robert A.}",
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T1 - Midterm results of edge-to-edge mitral valve repair without annuloplasty

AU - Maisano, Francesco

AU - Caldarola, Alessandro

AU - Blasio, Andrea

AU - De Bonis, Michele

AU - La Canna, Giovanni

AU - Alfieri, Ottavio

AU - Chitwood, W. Randolph

AU - Acar, Christophe

AU - Adams, David H.

AU - Dion, Robert A.

PY - 2003/12

Y1 - 2003/12

N2 - Objective: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. Methods: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. Results: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% ± 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% ± 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% ± 22% vs 95% ± 4.6% freedom from reoperation, P = .03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. Conclusions: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.

AB - Objective: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. Methods: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. Results: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% ± 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% ± 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% ± 22% vs 95% ± 4.6% freedom from reoperation, P = .03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. Conclusions: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.

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