Repair of congenital malformations of the mitral valve: Early and midterm results

Edvin Prifti, Vittorio Vanini, Massimo Bonacchi, Giacomo Frati, Massimo Bernabei, Gabriele Giunti, Adrian Crucean, Stefano Vincenzo Luisi, Bruno Murzi

Research output: Contribution to journalArticle

Abstract

Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 ± 3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 ± 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3 ± 0.7. Results. The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 ± 2.2 mm Hg (p <0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 ± 0.6 (p <0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p <0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.

Original languageEnglish
Pages (from-to)614-621
Number of pages8
JournalAnnals of Thoracic Surgery
Volume73
Issue number2
DOIs
Publication statusPublished - 2002

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Mitral Valve
Reoperation
Survival
Mitral Valve Stenosis
Mitral Valve Insufficiency
Heart Ventricles
Doppler Color Echocardiography
Atrioventricular Block
Hospital Mortality
Heart Atria
Multivariate Analysis
Hemorrhage
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Repair of congenital malformations of the mitral valve : Early and midterm results. / Prifti, Edvin; Vanini, Vittorio; Bonacchi, Massimo; Frati, Giacomo; Bernabei, Massimo; Giunti, Gabriele; Crucean, Adrian; Luisi, Stefano Vincenzo; Murzi, Bruno.

In: Annals of Thoracic Surgery, Vol. 73, No. 2, 2002, p. 614-621.

Research output: Contribution to journalArticle

Prifti, E, Vanini, V, Bonacchi, M, Frati, G, Bernabei, M, Giunti, G, Crucean, A, Luisi, SV & Murzi, B 2002, 'Repair of congenital malformations of the mitral valve: Early and midterm results', Annals of Thoracic Surgery, vol. 73, no. 2, pp. 614-621. https://doi.org/10.1016/S0003-4975(01)03419-1
Prifti, Edvin ; Vanini, Vittorio ; Bonacchi, Massimo ; Frati, Giacomo ; Bernabei, Massimo ; Giunti, Gabriele ; Crucean, Adrian ; Luisi, Stefano Vincenzo ; Murzi, Bruno. / Repair of congenital malformations of the mitral valve : Early and midterm results. In: Annals of Thoracic Surgery. 2002 ; Vol. 73, No. 2. pp. 614-621.
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title = "Repair of congenital malformations of the mitral valve: Early and midterm results",
abstract = "Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 ± 3.3 years (range 20 days to 15 years). Twenty-five (26.6{\%}) children were less than 1 year old. Isolated MV disease was found in 21 (22.4{\%}) patients. MV stenosis was the predominant lesion in 21 (22.4{\%}) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 ± 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6{\%}) patients with a mean regurgitation grade of 3.3 ± 0.7. Results. The hospital mortality was 8.5{\%} (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 ± 2.2 mm Hg (p <0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 ± 0.6 (p <0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2{\%} and 76.3{\%}, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p <0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.",
author = "Edvin Prifti and Vittorio Vanini and Massimo Bonacchi and Giacomo Frati and Massimo Bernabei and Gabriele Giunti and Adrian Crucean and Luisi, {Stefano Vincenzo} and Bruno Murzi",
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T1 - Repair of congenital malformations of the mitral valve

T2 - Early and midterm results

AU - Prifti, Edvin

AU - Vanini, Vittorio

AU - Bonacchi, Massimo

AU - Frati, Giacomo

AU - Bernabei, Massimo

AU - Giunti, Gabriele

AU - Crucean, Adrian

AU - Luisi, Stefano Vincenzo

AU - Murzi, Bruno

PY - 2002

Y1 - 2002

N2 - Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 ± 3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 ± 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3 ± 0.7. Results. The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 ± 2.2 mm Hg (p <0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 ± 0.6 (p <0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p <0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.

AB - Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 ± 3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 ± 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3 ± 0.7. Results. The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 ± 2.2 mm Hg (p <0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 ± 0.6 (p <0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p <0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.

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