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

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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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