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J Thorac Cardiovasc Surg 2001;122:674-681
© 2001 The American Association for Thoracic Surgery
Surgery for Aquired Cardiovascular Disease (ACD) |
From the Division of Cardiac Surgery, IRCCS S. Raffaele Hospital, Milan, Italy.
Received for publication Oct 16, 2000. Revisions requested Nov 13, 2000; revisions received April 9, 2001. Accepted for publication April 30, 2001. Address for reprints: Ottavio Alfieri, MD, Divisione di Cardiochirurgia, Ospedale S. Raffaele, Via Olgettina 60, 20132, Milano, Italy (E-mail: ottavio.alfieri{at}hsr.it).
Abstract
Objective: The aim of this study is to report our results with the central doubleorifice technique used for the treatment of complex mitral valve lesions.
Methods: The central double-orifice repair has been used in 260 patients (mean age, 56 ± 14.3 years) over a period of 7 years. The mechanism responsible for mitral regurgitation was prolapse of both leaflets in 148 patients, prolapse of the anterior leaflet in 68, prolapse of the posterior leaflet with annular calcification or other unfavorable features in 31, and lack of leaflet coaptation for restricted motion or erosion of the free edge in 13. Degenerative disease was the cause of mitral regurgitation in 80.8% of the patients, rheumatic disease was the cause in 9.6%, endocarditis was the cause in 6.1%, and ischemic disease was the cause in 2.3%.
Results: Hospital mortality was 0.7%, and the overall survival at 5 years was 94.4% ± 2.59%. Thirteen patients required a reoperation (2 early postoperatively and 11 late during the follow-up), for an overall freedom from reoperation of 90.0% ± 3.37% at 5 years. Freedom from reoperation was lower in patients with rheumatic valve disease and in patients who did not undergo an annuloplasty procedure.
Conclusions: The effectiveness and durability of the central double-orifice technique were assessed in this study. This type of repair can be a useful addition to the surgical armamentarium in mitral valve reconstruction.
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