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The Journal of Cardiovascular Surgery 2002 June;43(3):327-35


language: English

Surgical repair for degenerative and rheumatic mitral valve disease. Operative and mid-term results

Piciché M., El Khoury G., D’Udekem D’Akoz Y., Noirhomme P.

From the Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain Saint Luc Hospital, Brussels, Belgium


Back­ground. Non ran­dom­ized ­studies sug­gest ­that ­mitral ­valve ­repair for rheu­matic dis­ease is tech­ni­cally ­more dif­fi­cult ­than ­repair for degen­er­a­tive dis­ease, and ­that oper­a­tive and ­late ­results are ­worse. New sur­gical tech­niques ­have ­been devel­oped in our and ­other insti­tutes ­during the ­last 5 ­years, and ­this ­moved us to ­review the expe­ri­ence ­with ­these two pathol­o­gies and to com­pare the oper­a­tive and mid-­term ­results.
­Methods. ­From ­March 1996 to Sep­tember 1997, 66 ­patients under­went pri­mary ­mitral ­valve ­repair for treat­ment of degen­er­a­tive or rheu­matic dis­ease. ­Fifty-two ­patients (79%) ­were in the ­former ­group (­group A) and 14 in the ­latter (­group B). Sur­gery was per­formed by 2 expe­ri­enced car­diac sur­geons. A new tech­nique to cal­cu­late the ­exact arti­fi­cial ­chordae ­length was intro­duced. In 2 ­cases, tri­cuspid auto­grafts ­were trans­posed to ­mitral posi­tion and rein­forced ­with arti­fi­cial ­chordae. ­Patients ­were fol­lowed ­both clin­i­cally and echoc­ar­di­o­graph­i­cally. The ­follow-up ­data ­were col­lected in a 1-­month ­period (May 2000). The ­average clin­ical ­follow-up was 3.1±0.9 ­years (­range 1.7 to 4.2 ­years) ­while the ­average echoc­ar­di­o­graphic ­follow-up was 2.7±0.7 ­years (­range 9 ­months to 4 ­years). All ­values ­were ­expressed by ­means of the ­average and stan­dard devi­a­tion. χ2 and ­Student’s “t”-­test ­were ­used to ana­lyze the sig­nif­i­cance ­between var­i­ables. The ­Kaplan-­Meyer ­method was ­used for actu­arial sta­tis­tics.
­Results. ­There ­were no oper­a­tive ­deaths in ­either ­group. In ­group A, 1 ­patient under­went a ­second sur­gical ­repair 1 ­week ­later, suc­cess­fully. In ­group B no ­patients under­went reop­er­a­tion ­within 30 ­days or ­during the ­initial hos­pi­tal­iza­tion. At ­follow-up of ­group A ­there ­were the fol­lowing ­events: ­deaths ­from ­cancer (n=2), endo­car­ditis (n=1), ­aortic dis­sec­tion (n=1). At ­follow-up of ­group B ­there ­were ­mitral ­valve replace­ment (1 ­year ­after ­first oper­a­tion, n=1), ­Ross pro­ce­dure (n=1), ­ischemic ­heart ­failure (n=1). ­Among the ­remaining 62 ­patients fol­lowed, 32 ­were in ­NYHA ­class I, 15 in ­class II, 3 in ­class III, and ­none in ­class IV, in ­group A. In ­group B, 7 ­patients ­were in ­class I, 4 in ­class II, 1 in ­class III and ­none in ­class IV (p=ns). In ­group A ­mitral regur­gi­ta­tion was ­absent in 23 ­patients, ­mild in 21, mod­erate in 6, ­while in ­group B it was ­absent in 4, ­mild in 6, and mod­erate in 2 (p=ns). In ­both ­groups ­there ­were no ­cases of ­severe insuf­fi­ciency. The ­mean gra­dient was 1.1±1.7 ­mmHg in ­group A (­median=0), and 2.4±3.1 ­mmHg in ­group B (median=0), (p=ns). No ­case of sys­tolic ante­rior move­ment was ­seen at mid-­term. The ­event ­free-sur­vival ­rate was 92.8% in ­group A and 92.3% in B.
Con­clu­sions. Per­fecting and inno­va­tion of sur­gical tech­niques ­make pos­sible now­a­days to ­reach ­good and equiv­a­lent oper­a­tive and mid-­term ­results in ­both pathol­o­gies.

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