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The Journal of Cardiovascular Surgery 1999 Febbraio;40(1):93-9

lingua: Inglese

Mitral ­valve pro­lapse. Comparison ­between val­vu­lar ­repair and replace­ment in ­severe ­mitral regur­gi­ta­tion

Gra­ma­glia B., Ima­zio M., Chec­co L., Vil­la­ni M. *, Mor­ea M. *, Di Sum­ma M. *, Bon­a­mi­ni R., Roset­ta­ni E., Man­giar­di L.

From the University Cardiology Division * University Cardiac Surgery Division Molinette Hospital, Turin, Italy


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Background. The aim of ­this ­study was to ana­lyse ­long ­term ­results of ­mitral ­valve ­repair of degen­er­a­tive ­mitral regur­gi­ta­tion com­pared to ­valve replace­ment.
Methods. A hun­dred-twen­ty-­five con­sec­u­tive ­patients ­with ­severe ­mitral ­valve insuf­fi­cien­cy who under­went car­diac sur­gery ­from January 1987 to December 1995 ­were includ­ed in the ­study. Mean age was 55±16 ­years (77 ­males, 48 ­females). Mitral ­repair was per­formed in 62 ­patients and ­mitral ­valve was ­replaced in 63 ­patients. Mean fol­low-up was 5 ­years. The ­repair pro­ce­dures ­were ­based on quad­ran­gu­lar resec­tion of the pos­te­ri­or leaf­let, chord­al replace­ment and trans­po­si­tion. Annuloplasty was per­formed in 100% of cas­es. The tech­nique of ­valve replace­ment was con­ven­tion­al ­with com­plete exci­sion of the ­valve in the major­ity of cas­es.
Results. Operative mor­tal­ity fol­low­ing ­valve ­repair was 1.6%, no ­death ­occurred in the pros­thes­ic ­group. In the ­repair ­group over­all sur­vi­val and re-op­er­a­tion ­rate ­were respec­tive­ly 95.2% and 6.5%, ­while in the replace­ment ­group ­were 93.7% and 7.9%. No endo­car­ditis and throm­boem­bol­ic acci­dents ­were ­observed fol­low­ing val­vu­lo­plas­ty, ­while in the pros­the­ses 6.3% of ­patients had endo­car­ditis and 1.6% had a throm­boem­bol­ic ­event. Mild or mod­er­ate ­left ven­tric­u­lar dys­func­tion was ­present in 5 ­patients ­after val­vu­lo­plas­ty and in 9 ­patients ­with pros­the­ses.
Conclusions. Considering ­these ­results we con­clude ­that, in ­patients ­with ­severe degen­er­a­tive ­mitral insuf­fi­cien­cy, ­mitral ­valve ­repair is war­rant­ed when­ev­er it is pos­sible. The advan­tag­es giv­en by main­tain­ing the ­native ­valve sug­gest ­that sur­gery ­should be con­sid­ered in asymp­to­mat­ic ­patients ­before the occur­rence of the ­left ven­tric­u­lar dys­func­tion.

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