Mitral valve repair for isolated prolapse of the anterior leaflet: An 11-year follow-up

Pasquale Totaro, Eduardo Tulumello, Paolo Fellini, Manfredo Rambaldini, Giovanni La Canna, Giuseppe Coletti, Mario Zogno, Roberto Lorusso

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: Mitral valve insufficiency (MVI) because of involvement of the anterior mitral leaflet may pose additional risks for late outcome after mitral valve repair, because of more complex techniques. We retrospectively reviewed our experience in patients operated on for isolated anterior mitral leaflet prolapse approached by various techniques. Methods: Between 1986 and 1997, 616 patients underwent mitral valve repair at our Institution. Isolated pathology of the anterior mitral leaflet was the cause of MVI in 84 patients (13.6%). Age ranged from 23 to 74 years (mean 50 ± 14). Etiology of MVI was predominantly degenerative (57 patients, 67.8%), and the mechanism of the regurgitation was mainly due to a chordal rupture (58 patients, 69%). Annular dilatation was present in 75 patients (89.5%). A variety of surgical techniques were applied including chordal shortening (five patients, 5.9%), chordal transposition (three patients, 3.5%), artificial chordae (11 patients, 13%). Since 1992, however, the majority of procedures was performed using the 'edge to edge' technique (52 patients, 51.9%). Annular dilatation was treated mainly by means of a prosthetic ring (46 patients, 61.3%) whereas 18 patients (24%) underwent posterior annuloplasty using gluteraldehyde- treated native pericardium. Results: Follow-up ranged from 3 to 122 months (mean 46 ± 24 months). There were three hospital deaths (3.5%) and five late deaths (5.9%) for a Kaplan-Meier estimated survival of 87.6% at 8 years. Three patients underwent early reoperation within 30 days (3.5%), and six patients underwent late reoperation (7.1%), for a cumulative freedom from reoperation of 85.4% at 8 years. Seventy-four percent of the survivors (50 patients) are still in New York Heart Association Class I, and 92% of survivors (62 patients) have no or trivial (1+) residual mitral regurgitation at echocardiographic follow-up. Conclusion: In spite of the greater complexity, conservative surgery to correct anterior mitral valve prolapse pertains high success rate at long term. Recent technical modifications ('edge-to-edge' technique) may allow more expeditious and reproducible procedures with expected favorable influence of mitral valve repair applicability.

Original languageEnglish
Pages (from-to)119-126
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume15
Issue number2
DOIs
Publication statusPublished - 1999

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Prolapse
Mitral Valve
Mitral Valve Insufficiency
Reoperation
Survivors
Dilatation
Mitral Valve Prolapse
Pericardium

Keywords

  • Anterior leaflet prolapse
  • Mitral regurgitation
  • Mitral valve repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mitral valve repair for isolated prolapse of the anterior leaflet : An 11-year follow-up. / Totaro, Pasquale; Tulumello, Eduardo; Fellini, Paolo; Rambaldini, Manfredo; La Canna, Giovanni; Coletti, Giuseppe; Zogno, Mario; Lorusso, Roberto.

In: European Journal of Cardio-thoracic Surgery, Vol. 15, No. 2, 1999, p. 119-126.

Research output: Contribution to journalArticle

Totaro, Pasquale ; Tulumello, Eduardo ; Fellini, Paolo ; Rambaldini, Manfredo ; La Canna, Giovanni ; Coletti, Giuseppe ; Zogno, Mario ; Lorusso, Roberto. / Mitral valve repair for isolated prolapse of the anterior leaflet : An 11-year follow-up. In: European Journal of Cardio-thoracic Surgery. 1999 ; Vol. 15, No. 2. pp. 119-126.
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abstract = "Objective: Mitral valve insufficiency (MVI) because of involvement of the anterior mitral leaflet may pose additional risks for late outcome after mitral valve repair, because of more complex techniques. We retrospectively reviewed our experience in patients operated on for isolated anterior mitral leaflet prolapse approached by various techniques. Methods: Between 1986 and 1997, 616 patients underwent mitral valve repair at our Institution. Isolated pathology of the anterior mitral leaflet was the cause of MVI in 84 patients (13.6{\%}). Age ranged from 23 to 74 years (mean 50 ± 14). Etiology of MVI was predominantly degenerative (57 patients, 67.8{\%}), and the mechanism of the regurgitation was mainly due to a chordal rupture (58 patients, 69{\%}). Annular dilatation was present in 75 patients (89.5{\%}). A variety of surgical techniques were applied including chordal shortening (five patients, 5.9{\%}), chordal transposition (three patients, 3.5{\%}), artificial chordae (11 patients, 13{\%}). Since 1992, however, the majority of procedures was performed using the 'edge to edge' technique (52 patients, 51.9{\%}). Annular dilatation was treated mainly by means of a prosthetic ring (46 patients, 61.3{\%}) whereas 18 patients (24{\%}) underwent posterior annuloplasty using gluteraldehyde- treated native pericardium. Results: Follow-up ranged from 3 to 122 months (mean 46 ± 24 months). There were three hospital deaths (3.5{\%}) and five late deaths (5.9{\%}) for a Kaplan-Meier estimated survival of 87.6{\%} at 8 years. Three patients underwent early reoperation within 30 days (3.5{\%}), and six patients underwent late reoperation (7.1{\%}), for a cumulative freedom from reoperation of 85.4{\%} at 8 years. Seventy-four percent of the survivors (50 patients) are still in New York Heart Association Class I, and 92{\%} of survivors (62 patients) have no or trivial (1+) residual mitral regurgitation at echocardiographic follow-up. Conclusion: In spite of the greater complexity, conservative surgery to correct anterior mitral valve prolapse pertains high success rate at long term. Recent technical modifications ('edge-to-edge' technique) may allow more expeditious and reproducible procedures with expected favorable influence of mitral valve repair applicability.",
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T2 - An 11-year follow-up

AU - Totaro, Pasquale

AU - Tulumello, Eduardo

AU - Fellini, Paolo

AU - Rambaldini, Manfredo

AU - La Canna, Giovanni

AU - Coletti, Giuseppe

AU - Zogno, Mario

AU - Lorusso, Roberto

PY - 1999

Y1 - 1999

N2 - Objective: Mitral valve insufficiency (MVI) because of involvement of the anterior mitral leaflet may pose additional risks for late outcome after mitral valve repair, because of more complex techniques. We retrospectively reviewed our experience in patients operated on for isolated anterior mitral leaflet prolapse approached by various techniques. Methods: Between 1986 and 1997, 616 patients underwent mitral valve repair at our Institution. Isolated pathology of the anterior mitral leaflet was the cause of MVI in 84 patients (13.6%). Age ranged from 23 to 74 years (mean 50 ± 14). Etiology of MVI was predominantly degenerative (57 patients, 67.8%), and the mechanism of the regurgitation was mainly due to a chordal rupture (58 patients, 69%). Annular dilatation was present in 75 patients (89.5%). A variety of surgical techniques were applied including chordal shortening (five patients, 5.9%), chordal transposition (three patients, 3.5%), artificial chordae (11 patients, 13%). Since 1992, however, the majority of procedures was performed using the 'edge to edge' technique (52 patients, 51.9%). Annular dilatation was treated mainly by means of a prosthetic ring (46 patients, 61.3%) whereas 18 patients (24%) underwent posterior annuloplasty using gluteraldehyde- treated native pericardium. Results: Follow-up ranged from 3 to 122 months (mean 46 ± 24 months). There were three hospital deaths (3.5%) and five late deaths (5.9%) for a Kaplan-Meier estimated survival of 87.6% at 8 years. Three patients underwent early reoperation within 30 days (3.5%), and six patients underwent late reoperation (7.1%), for a cumulative freedom from reoperation of 85.4% at 8 years. Seventy-four percent of the survivors (50 patients) are still in New York Heart Association Class I, and 92% of survivors (62 patients) have no or trivial (1+) residual mitral regurgitation at echocardiographic follow-up. Conclusion: In spite of the greater complexity, conservative surgery to correct anterior mitral valve prolapse pertains high success rate at long term. Recent technical modifications ('edge-to-edge' technique) may allow more expeditious and reproducible procedures with expected favorable influence of mitral valve repair applicability.

AB - Objective: Mitral valve insufficiency (MVI) because of involvement of the anterior mitral leaflet may pose additional risks for late outcome after mitral valve repair, because of more complex techniques. We retrospectively reviewed our experience in patients operated on for isolated anterior mitral leaflet prolapse approached by various techniques. Methods: Between 1986 and 1997, 616 patients underwent mitral valve repair at our Institution. Isolated pathology of the anterior mitral leaflet was the cause of MVI in 84 patients (13.6%). Age ranged from 23 to 74 years (mean 50 ± 14). Etiology of MVI was predominantly degenerative (57 patients, 67.8%), and the mechanism of the regurgitation was mainly due to a chordal rupture (58 patients, 69%). Annular dilatation was present in 75 patients (89.5%). A variety of surgical techniques were applied including chordal shortening (five patients, 5.9%), chordal transposition (three patients, 3.5%), artificial chordae (11 patients, 13%). Since 1992, however, the majority of procedures was performed using the 'edge to edge' technique (52 patients, 51.9%). Annular dilatation was treated mainly by means of a prosthetic ring (46 patients, 61.3%) whereas 18 patients (24%) underwent posterior annuloplasty using gluteraldehyde- treated native pericardium. Results: Follow-up ranged from 3 to 122 months (mean 46 ± 24 months). There were three hospital deaths (3.5%) and five late deaths (5.9%) for a Kaplan-Meier estimated survival of 87.6% at 8 years. Three patients underwent early reoperation within 30 days (3.5%), and six patients underwent late reoperation (7.1%), for a cumulative freedom from reoperation of 85.4% at 8 years. Seventy-four percent of the survivors (50 patients) are still in New York Heart Association Class I, and 92% of survivors (62 patients) have no or trivial (1+) residual mitral regurgitation at echocardiographic follow-up. Conclusion: In spite of the greater complexity, conservative surgery to correct anterior mitral valve prolapse pertains high success rate at long term. Recent technical modifications ('edge-to-edge' technique) may allow more expeditious and reproducible procedures with expected favorable influence of mitral valve repair applicability.

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KW - Mitral regurgitation

KW - Mitral valve repair

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