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J Thorac Cardiovasc Surg 2006;131:99-106
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Seven years' experience with suture annuloplasty for mitral valve repair

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Received for publication March 10, 2005; revisions received July 20, 2005; accepted for publication July 21, 2005.

^_* Address for reprints: Tayfun Aybek, MD, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590 Frankfurt at Main, Germany (Email: Tayfun{at}Aybek.de).

OBJECTIVE: Our early experience with the mural annulus shortening suture procedure for mitral valve repair showed superior hemodynamic performance over ring annuloplasty. The aim of this study was to assess the durability of the mural annulus shortening suture procedure and evaluate our 7-year experience regarding valve function, hemodynamic performance, and clinical outcome.

METHODS: Between 1996 and 2003, 222 elective consecutive patients (58.1% males; age, 59 ± 14 years) underwent simple or complex mitral valve repair. Minimal invasive reconstruction was performed in 150 patients. For correction of annular dilatation, we used double-running 2-0 polytetrafluoroethylene sutures to reinforce the posterior circumference of the annulus. Patients were investigated prospectively by means of transthoracic echocardiography before discharge and 1 and 5 years after the operation. The mean follow up was 32 ± 21 months (range 1-77 months).

RESULTS: The operative mortality was 3.1%. Hemodynamic performance at 1 and 5 years showed low mean transvalvular gradients (2.1 ± 0.9 and 2.0 ± 0.8 mm Hg, respectively) and a calculated mitral valve orifice area of 3.3 ± 0.9 cm² and 3.1 ± 0.6 cm², respectively, with progressive annular dilatation from 31.2 ± 3 mm to 33.9 ± 4 mm at 1 year and 35.7 ± 4 mm at 5 years (P < .01). Clinical status improved from New York Heart Association class 3.0 ± 0.4 to 0.6 ± 0.8 at 1 year and 0.8 ± 0.8 at 5 years. Freedom form nontrivial residual mitral regurgitation was 82.3%, freedom from reoperation was 95.1% and actuarial survival was 87.2%, all at 77 months.

CONCLUSIONS: The midterm results show satisfactory hemodynamic performance and clinical improvement. Valve competence and reoperation rates are comparable with those of other reports. Durability of the mural annulus shortening suture procedure for mitral valve repair is questioned because progressive annular redilatation occurs.

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