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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2000 Aprile;41(2):187-92

lingua: Inglese

Early and late results of mitral valve repair for mitral valve regurgitation. Significant risk factors of reoperation

Kuwaki K., Kiyofumi M., Tsukamoto M., Abe T.

From the Departments of Thoracic and Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo, Hokkaido, Japan


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Background. Mitral ­valve ­repair for ­mitral ­valve regur­gi­ta­tion has ­many advan­tag­es ­over ­mitral ­valve replace­ment. However, dur­abil­ity and reop­er­a­tion ­after ­mitral ­valve ­repair ­still ­remain ­major prob­lems. We exam­ined the out­come of ­mitral ­valve ­repair for ­mitral ­valve regur­gi­ta­tion and ana­lyzed sev­er­al pre- and intra­op­er­a­tive poten­tial ­risk fac­tors to deter­mine the sig­nif­i­cant ­risk fac­tors of reop­er­a­tion.
Methods. From February 1981 to November 1996, 86 ­patients under­went ­mitral ­valve ­repair for ­mitral regur­gi­ta­tion or com­bined ­mitral regur­gi­ta­tion and sten­o­sis. The ­mean age was 53 ­years, and 88.4% ­were New York Heart Association ­class III or IV. The caus­es of ­mitral ­valve dis­ease ­were degen­er­a­tive dis­ease in 53 ­patients, rheu­mat­ic dis­ease in 15, infec­tive endo­car­ditis in 11, and ischem­ic dis­ease in 7. There ­were 2 ear­ly and 8 ­late ­deaths.
Results. Actuarial over­all sur­vi­val includ­ing ear­ly ­death at 10 ­years was 83.2±6.1%, free­dom ­from reop­er­a­tion was 86.8±5.3%, free­dom ­from throm­boem­bo­lism was 90.9±6.2%, and free­dom ­from infec­tive endo­car­ditis was 98.5±1.5%. There was no bleed­ing ­event. At the ­last fol­low-up, ­most ­patients ­were in New York Heart Association ­class I or II. Prolapse of ante­ri­or leaf­let and rheu­mat­ic ­mitral regur­gi­ta­tion ­were iden­ti­fied as inde­pen­dent pre­dic­tors for reop­er­a­tion.
Conclusions. The ­repair tech­niques for ante­ri­or leaf­let pro­lapse and ­patient selec­tion in rheu­mat­ic ­mitral dis­ease are impor­tant for improv­ing ­long-­term ­results of ­mitral ­valve ­repair for ­mitral regur­gi­ta­tion.

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