HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lessana, A. Articles by Aime, F. Search for Related Content PubMed PubMed Citation Articles by Lessana, A. Articles by Aime, F.

The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 622-630, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases

A Lessana, C Carbone, M Romano, E Palsky, YH Quan, M Escorsin, B Jegier, A Ruffenach, G Lutfalla and F Aime
Le Service de Chirurgie Cardio-vasculaire CHPA La Roseraie, Aubervilliers, France.

From January 1975 to June 1988, 275 patients underwent mitral valve repair for mitral regurgitation, pure (148 patients) or associated with mitral stenosis (127 patients). Patients with pure mitral stenosis were excluded from this study. The cause of mitral regurgitation was rheumatic in 180 patients (aged 28.6 +/- 1.2 years, mean +/- standard error of the mean) and degenerative in 84 patients (aged 54.7 +/- 1.5 years). Fifty-nine percent of the patients were in New York Heart Association classes III and IV before the operation. Intraoperative assessment of the mitral valve led us to identify four major mechanisms of mitral regurgitation: (1) restriction of leaflet motion by fibrosis (group I, 63 patients); (2) enhancement of leaflet motion by leaflet and chordal extension and prolapse (group II, 139 patients), (3) combination of both (group III, 64 patients); and (4) isolated dilatation of the anulus (group IV, 10 patients). One hundred sixty-one patients had isolated mitral disease and 114 had associated aortic or tricuspid valve disease, or both. The hospital mortality rate was 4.0%. Follow-up was 96% complete and totaled 1247.47 patient-years. At 13 years' follow-up, the survival rate was 93.0% +/- 6.8% in group I, 90.0% +/- 6.0% in group II, and 96.6% +/- 4.6% in group III. Freedom from reoperation was 78.1% +/- 21.0%, 83.2% +/- 18.9%, and 79.6% +/- 16.2%, respectively. Freedom from embolism was 94.7% for the whole series. In patients with isolated mitral valve repair, the cumulative morbidity was significantly higher in groups I (6.3 +/- 2.0%/pt-yr) and III 6.3% +/- 1.7%/pt-yr) than in group II (2.5% +/- 0.9%/pt-yr, p less than 0.05). Multivariate analysis identified age and associated tricuspid valve disease as significant predictors of reoperation (p less than 0.01 for both factors). These results suggest that conservative surgery should be used with caution in group I and III patients. In contrast, indications for mitral valve repair should be extended in group II patients. This observation has important clinical implications since, in Western countries, valve prolapse tends to be a major cause of mitral regurgitation.

This article has been cited by other articles:

				R. Hetzer, E. B. M. D. Walter, M. Hubler, V. Alexi-Meskishvili, Y. Weng, N. Nagdyman, and F. Berger Modified Surgical Techniques and Long-Term Outcome of Mitral Valve Reconstruction in 111 Children Ann. Thorac. Surg., August 1, 2008; 86(2): 604 - 613. [Abstract] [Full Text] [PDF]

				R. Bellitti, P. Sante, G. Dialetto, F. E. Covino, D. Iarussi, G. Messina, and L. Maresca "Z-Plasty Suture": A New Procedure for Complex Reconstructions of Posterior Mitral Leaflet Ann. Thorac. Surg., July 1, 2007; 84(1): 306 - 308. [Abstract] [Full Text] [PDF]

				O. Honjo, Y. Kotani, S. Osaki, Y. Fujita, T. Suezawa, A. Tateishi, K. Ishino, M. Kawada, T. Akagi, and S. Sano Discrepancy Between Intraoperative Transesophageal Echocardiography and Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2240 - 2246. [Abstract] [Full Text] [PDF]

				H. J. Shin, Y. J. Lee, S. J. Choo, H. Song, C. H. Chung, and J. W. Lee Analysis of Recurrent Mitral Regurgitation after Mitral Valve Repair Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 261 - 266. [Abstract] [Full Text] [PDF]

				D. Mohty, T. A. Orszulak, H. V. Schaff, J.-F. Avierinos, J. A. Tajik, and M. Enriquez-Sarano Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse Circulation, September 18, 2001; 104 (2009): I-1 - I-7. [Abstract] [Full Text] [PDF]

				M. R. Phillips, R. C. Daly, H. V. Schaff, J. A. Dearani, C. J. Mullany, and T. A. Orszulak Repair of anterior leaflet mitral valve prolapse: chordal replacement versus chordal shortening Ann. Thorac. Surg., January 1, 2000; 69(1): 25 - 29. [Abstract] [Full Text] [PDF]

				P. Totaro, E. Tulumello, P. Fellini, M. Rambaldini, G. La Canna, G. Coletti, M. Zogno, and R. Lorusso Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up Eur. J. Cardiothorac. Surg., February 1, 1999; 15(2): 119 - 126. [Abstract] [Full Text] [PDF]

				J.-F. G. Fuzellier, S. M. Chauvaud, P. Fornes, A. J. Berrebi, P. S. Lajos, P. Bruneval, and A. F. Carpentier Surgical management of mitral regurgitation associated with marfan's syndrome Ann. Thorac. Surg., July 1, 1998; 66(1): 68 - 72. [Abstract] [Full Text] [PDF]

				E. M. Lee, L. M. Shapiro, and F. C. Wells Conservative Operation for Infective Endocarditis of the Mitral Valve Ann. Thorac. Surg., April 1, 1998; 65(4): 1087 - 1092. [Abstract] [Full Text] [PDF]

				E. M. Lee, L. M. Shapiro, and F. C. Wells Midterm Results of Mitral Valve Repair With the Sculptor Annuloplasty Ring Ann. Thorac. Surg., May 1, 1997; 63(5): 1340 - 1345. [Abstract] [Full Text]

				M. S. Uva, G. Dreyfus, G. Rescigno, N. A. Aile, R. Mascagni, M. La Marra, F. Pouillart, S. Pargaonkar, E. Palsky, R. Raffoul, et al. SURGICAL TREATMENT OF ASYMPTOMATIC AND MILDLY SYMPTOMATIC MITRAL REGURGITATION J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1240 - 1249. [Abstract] [Full Text]

				N. G. Smedira, R. Selman, D. M. Cosgrove, P. M. McCarthy, B. W. Lytle, P. C. Taylor, C. Apperson-Hansen, R. W. Stewart, and F. D. Loop REPAIR OF ANTERIOR LEAFLET PROLAPSE: CHORDAL TRANSFER IS SUPERIOR TO CHORDAL SHORTENING J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 287 - 292. [Abstract] [Full Text]

				M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, K. R. Bailey, A. J. Tajik, and R. L. Frye Congestive Heart Failure After Surgical Correction of Mitral Regurgitation : A Long-term Study Circulation, November 1, 1995; 92(9): 2496 - 2503. [Abstract] [Full Text]

				T. E. David Update on Mitral Valve Repair Ann. Thorac. Surg., May 1, 1995; 59(5): 1257 - 1258. [Full Text]

				M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, A. J. Tajik, K. R. Bailey, and R. L. Frye Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation : A Multivariate Analysis Circulation, February 15, 1995; 91(4): 1022 - 1028. [Abstract] [Full Text]

				G. L. Kay, A. Aoki, P. Zubiate, C. A. Prejean Jr., J. M. Ruggio, and J. H. Kay Probability of valve repair for pure mitral regurgitation J. Thorac. Cardiovasc. Surg., November 1, 1994; 108(5): 871 - 879. [Abstract] [Full Text]

				T. Shimono, H. Yuasa, T. Mizumoto, K. Hatanaka, H. Kusagawa, and I. Yada New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidanceAn experimental study J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 719 - 726. [Abstract] [Full Text]