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J Thorac Cardiovasc Surg 2003;126:1987-1997
© 2003 The American Association for Thoracic Surgery
Surgery for acquired cardiovascular disease |
a Cardiac Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.
Received for publication April 30, 2003; revisions received June 22, 2003; accepted for publication July 10, 2003.
* Address for reprints: Francesco Maisano, MD, Cardiochirurgia, Ospedale San Raffaele, Via Olgettina 60, 20132, Milano, Italy
francesco.maisano{at}hsr.it
OBJECTIVE: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches.
METHODS: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure.
RESULTS: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% ± 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% ± 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% ± 22% vs 95% ± 4.6% freedom from reoperation, P = .03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors.
CONCLUSIONS: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.
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