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J Thorac Cardiovasc Surg 2005;130:1242-1249
© 2005 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
Division of Cardiovascular Surgery and Cardiology of Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.
Received for publication April 2, 2005; revisions received June 19, 2005; accepted for publication June 30, 2005. * Address for reprints: Tirone E. David, MD, 200 Elizabeth St, 4N457, Toronto, Ontario M5G 2C4, Canada (Email: tirone.david{at}uhn.on.ca).
OBJECTIVE: We sought to compare the clinical and echocardiographic outcomes of mitral valve repair for mitral regurgitation in patients with degenerative disease of the mitral valve with posterior, anterior, or bileaflet prolapse.
METHODS: Patients underwent operations from 1981 through 2001: 359 had posterior (mean age, 60.4 years), 92 had anterior (mean age, 53.3 years), and 250 had bileaflet (means age, 56.4 years) prolapse. Patients with anterior prolapse were younger (P = .04) and had more associated aortic valve disease (P = .02), particularly bicuspid aortic valve disease (P < .001). Anterior prolapse was corrected by using chordal replacement with Gore-Tex sutures in most patients, but early on in this series, leaflet resection, chordal shortening, and chordal transfer were also used. Echocardiograms were done annually, and clinical follow-up was complete at a mean of 6.9 ± 4.0 years (range, 0-23 years).
RESULTS: The overall survival at 12 years was 75% ± 5%, with no difference among the posterior, anterior, and bileaflet prolapse groups (P = .3). The freedom from reoperation at 12 years was 96% ± 2% for posterior, 88% ± 4% for anterior, and 94% ± 2% for bileaflet prolapse (P = .019). Anterior prolapse was the only independent predictor of reoperation. The freedom from moderate or severe mitral regurgitation at 12 years was 80% ± 4% for posterior, 65% ± 8% for anterior, and 67% ± 6% for bileaflet prolapse (P = .001). Anterior and bileaflet prolapse, age, ejection fraction of less than 40%, and aortic valve disease were independent predictors of recurrent moderate or severe mitral regurgitation.
CONCLUSIONS: The pathophysiology of mitral regurgitation affects the durability of mitral valve repair for degenerative disease, and the results of posterior prolapse are better than those of anterior and bileaflet prolapse. This study indicates that rates of reoperation underscore the rates of failure of mitral valve repair.
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