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The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 326-337, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CG Duran, JL Pomar, JM Revuelta, I Gallo, J Poveda, A Ochoteco, JL Ubago and LH Cohn
From May, 1974, through December, 1978, 255 mitral annuloplasties have been
performed at our institution. Forty-three Carpentier rings and 212 flexible
rings were used. Simultaneously, 307 patients with predominant
insufficiency were treated with a Hancock bioprosthesis. A critical
analysis of the flexible ring group versus the Hancock group is presented:
The average ages were 41.3 versus 43.3 years. Preoperatively, 55% versus
60% were in Functional Class III and 9.6 versus 25.4% were in Class IV. The
valve lesion was caused by rheumatic disease in 91.2% versus 93.9%. A
multiple valve operation was required by 51% versus 60%. There was a
significant difference in the operative mortality rates (1.8% versus
11.4%). This difference was maintained for each preoperative functional
class and for the isolated and multiple valve groups. There was no
significant difference in the late mortality rates (1.4% versus 3.7%). The
total actuarial survival rates were of 96.4% and 81% (maximum follow-up
times 4.0 and 4.5 years). The incidence of embolism was 2.4% and 4.1% per
patient-year, with both groups being subjected to the same anticoagulation
policy. The incidence of dysfunctions was equal (3.9% per patient-year).
Postoperative hemodynamic evaluation of 72 patients having annuloplasty and
129 patients having Hancock valve replacement showed basal mean transmitral
gradients of 10.98 +/- 3.6 and 9.66 +/- 2.73 mm Hg. The average effective
orifice areas were 1.93 +/- 0.74 and 2.25 +/- 0.46 cm2. While the
bioprosthesis behaves hemodynamically like a flow- related variable
orifice, the reconstructed valve orifice is dependent upon its preoperative
anatomy. In conclusion, the comparison of flexible ring annuloplasty and
Hancock valve replacement for mitral valve disease shows a lower operative
mortality for the former and comparable medium-term postoperative course.
Since both techniques have a limited durability, longer follow-up periods
will soon resolve this controversial issue.
ARTICLES
Conservative operation for mitral insufficiency: critical analysis supported by postoperative hemodynamic studies of 72 patients
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