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The Journal of Cardiovascular Surgery 2002 April;43(2):147-52

language: English

Mitral valve replacement in ischemic mitral regurgitation. Preservation of both anterior and posterior mitral leaflets

Morishita A., Shimakura T., Nonoyama M., Takasaki T.

From the Department of Cardiovascular Surgery Fukuyama Cardiovascular Hospital, Hiroshima, Japan


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Background. The sur­gi­cal ­risks asso­ciat­ed ­with ischem­ic ­mitral regur­gi­ta­tion are ­thought to be great­er ­than ­those for oth­er ­forms of ­mitral regur­gi­ta­tion. We ­have per­formed ­mitral ­valve replace­ment ­using the St. Jude Medical bileaf­let pros­the­ses ­with pres­er­va­tion of ­both leaf­lets, ­along ­with all of the chor­dae ten­di­neae and pap­il­lary mus­cles. The aim of ­this ­study was to ret­ro­spec­tive­ly eval­u­ate ­mitral ­valve replace­ment ­with pres­er­va­tion of ­both ­mitral ­valves ­with ­respect to ­long-­term clin­i­cal ­results and ­left ven­tric­u­lar per­for­mance.
Methods. Between January 1, 1988 and February 29, 2000, 15 ­patients ­were oper­at­ed on for ischem­ic ­mitral regur­gi­ta­tion. There ­were 7 ­males and 8 ­females, and the ­mean age was 69.7±8.1 ­years. The pre­op­er­a­tive var­i­ables ­showed clin­i­cal dete­ri­ora­tion of the ­state, ­such as emer­gen­cy oper­a­tion in 40% of the ­patients, ­more ­than ­NYHA func­tion­al III ­class in 93% of ­patients, car­di­o­gen­ic ­shock in 47% of the ­patients, a ­mean ­left ven­tric­u­lar ejec­tion frac­tion of 36.8%, and a ­mean ­left ven­tric­u­lar end-sys­tol­ic vol­ume ­index of 116.7 ml/m2.
Results. There ­were 5 (33.3%) hos­pi­tal ­deaths dur­ing the fol­low-up peri­od includ­ing 1 ear­ly ­death and 1 (10%) ­late ­death dur­ing the fol­low-up peri­od. Thus, the actu­ar­i­al sur­vi­val ­rate ­after 5 ­years for the ­whole was 60%. However, the ­left ven­tric­u­lar dimen­sions and ­left ven­tric­u­lar frac­tion­al short­en­ing, ­even if in ­patients ­with pro­found ­depressed ­left ven­tric­u­lar func­tion pre­op­er­a­tive­ly, ­showed main­te­nance of the car­diac func­tion.
Conclusions. These ­results sug­gest­ed ­that ­mitral ­valve replace­ment ­using the St. Jude Medical pros­the­ses ­with pres­er­va­tion of ­both leaf­lets and all chor­dae ten­di­neae and pap­il­lary mus­cles ­might be a pro­ce­dure of ­choice for ischem­ic ­mitral regur­gi­ta­tion.

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