Mitral valve remodeling

Long-term results with posterior pericardial annuloplasty

Roberto Scrofani, Stefano Moriggia, Maurizio Salati, Pino Fundaro, Paolo Danna, Carmine Santoli

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background. We studied the long-term results of a technique of mitral annuloplasty using autologous pericardium. Methods. Between June 1989 and December 1994, 113 mitral valvuloplasties were performed for myxomatous degenerative disease. Repair of isolated anterior leaflet prolapse was performed in 26 patients (23%), posterior leaflet prolapse in 38 (33.6%), and prolapse of both leaflets in 49 (43.4%). Posterior pericardial annuloplasty was performed in all patients. In 20 patients, the pericardial graft was marked with metal clips for postoperative cinefluoroscopic assessment of annulus motion. Results. The operative mortality rate was 2.7% (3/113). One patient died of a myocardial infarction and 2 of low cardiac output syndrome. One patient required replacement of the mitral valve 2 days after operation because of dehiscence of the annular plication. Follow-up (average length, 32.41 ± 20.09 months; range, 1 to 71 months) was 97% complete and revealed good clinical and functional results: 95 patients (84.1%) were in New York Heart Association class I and had no regurgitation or only mild residual regurgitation. Postoperative transmitral flow indices were almost normal (mitral valve area = 3.7 ± 0.4 cm2; peak flow velocity = 1.06 ± 0.2 m/s). Only 3 patients had reoperation within 3 years (actuarial 5-year reoperation-free rate, 89.7%) and event-free survival at 5 years was 91%. In patients with metal clips marking autologous pericardium, planimetry of the area derived by fluoroscopic examination showed systolic narrowing of annulus size (8.5% ± 6.4%; p <0.01) and a slight systolic fall in the anteroposterior diameter of the annulus contour (5.9% ± 3.8%; p <0.01). Conclusions. Posterior pericardial annuloplasty seems to be a safe, effective, and easily performed technique and a more physiologic correction that preserves mitral annulus motion.

Original languageEnglish
Pages (from-to)895-899
Number of pages5
JournalAnnals of Thoracic Surgery
Volume61
Issue number3
DOIs
Publication statusPublished - Mar 1996

Fingerprint

Mitral Valve
Prolapse
Pericardium
Reoperation
Surgical Instruments
Mitral Valve Annuloplasty
Metals
Low Cardiac Output
Disease-Free Survival
Myocardial Infarction
Transplants
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mitral valve remodeling : Long-term results with posterior pericardial annuloplasty. / Scrofani, Roberto; Moriggia, Stefano; Salati, Maurizio; Fundaro, Pino; Danna, Paolo; Santoli, Carmine.

In: Annals of Thoracic Surgery, Vol. 61, No. 3, 03.1996, p. 895-899.

Research output: Contribution to journalArticle

Scrofani, Roberto ; Moriggia, Stefano ; Salati, Maurizio ; Fundaro, Pino ; Danna, Paolo ; Santoli, Carmine. / Mitral valve remodeling : Long-term results with posterior pericardial annuloplasty. In: Annals of Thoracic Surgery. 1996 ; Vol. 61, No. 3. pp. 895-899.
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abstract = "Background. We studied the long-term results of a technique of mitral annuloplasty using autologous pericardium. Methods. Between June 1989 and December 1994, 113 mitral valvuloplasties were performed for myxomatous degenerative disease. Repair of isolated anterior leaflet prolapse was performed in 26 patients (23{\%}), posterior leaflet prolapse in 38 (33.6{\%}), and prolapse of both leaflets in 49 (43.4{\%}). Posterior pericardial annuloplasty was performed in all patients. In 20 patients, the pericardial graft was marked with metal clips for postoperative cinefluoroscopic assessment of annulus motion. Results. The operative mortality rate was 2.7{\%} (3/113). One patient died of a myocardial infarction and 2 of low cardiac output syndrome. One patient required replacement of the mitral valve 2 days after operation because of dehiscence of the annular plication. Follow-up (average length, 32.41 ± 20.09 months; range, 1 to 71 months) was 97{\%} complete and revealed good clinical and functional results: 95 patients (84.1{\%}) were in New York Heart Association class I and had no regurgitation or only mild residual regurgitation. Postoperative transmitral flow indices were almost normal (mitral valve area = 3.7 ± 0.4 cm2; peak flow velocity = 1.06 ± 0.2 m/s). Only 3 patients had reoperation within 3 years (actuarial 5-year reoperation-free rate, 89.7{\%}) and event-free survival at 5 years was 91{\%}. In patients with metal clips marking autologous pericardium, planimetry of the area derived by fluoroscopic examination showed systolic narrowing of annulus size (8.5{\%} ± 6.4{\%}; p <0.01) and a slight systolic fall in the anteroposterior diameter of the annulus contour (5.9{\%} ± 3.8{\%}; p <0.01). Conclusions. Posterior pericardial annuloplasty seems to be a safe, effective, and easily performed technique and a more physiologic correction that preserves mitral annulus motion.",
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