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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2012 August;25(4):325-9
Repair of ischemic mitral regurgitation with measuredposterior annuloplasty. A follow-up
Jyrala A. 1, Gatto N. M. 2, Kay G. L. 1
¹ Department of Cardiothoracic Surgery Heart Institute at Good Samaritan Hospital, Los Angeles, CA, USA;
² Department of Epidemiology, University of Southern California, Los Angeles, CA, USA
Patients (pts) with ischemic mitral regurgitation (IMR) are high-risk for surgery and have poor early and long-term outcomes. The aim of this study is to evaluate durability of measured posterior annuloplasty (MPA) used for repair.
Methods. Pts with IMR and repaired with MPA were identified from 1988 through 2002. Database was created including pre-per and postoperative characteristics. MPA is a piece of Duran ring measured to match the length of free edge of anterior mitral leaflet and anchored with several pledgeted mattress sutures into the posterior annulus from trigone to trigone.
Results. Fifty-eight pts with IMR had repair with MPA. Mean age was 68 years, 39.7% were females, 81% were in NYHA class III-IV. All but 1 pt had CABG. One pt had instant rerepair for persistent 3+ MR. Operative mortality was 1 pt and hospital/30 day mortality 4 pts. MR grade decreased from 3.6 to 0.24 postoperatively (p<0.0001). Follow-up mortality was 22 pts (41.5%) up to 6+ years. One pt needed reoperation for recurrence of MR caused by rheumatic changes in mitral valve. No other recurrences of significat (>2+) MR were reported, no significant stenoses were observed.
Conclusion. MPA is an alternative technique for repair of IMR. It does not restrict the mitral orifice and does not affect the movements during cardiac cycle. Subjectivity in sizing is eliminated. It is durable, stable and does not leave the patient with residual MR or MS. Freedom from MPA related reoperations is 100% up to 6+ years.