Michele De Bonis1, Elisabetta Lapenna2, Francesco Maisano2, Fabio Barili2, Giovanni La Canna2, Nicola Buzzatti2, Federico Pappalardo2, Mariachiara Calabrese2, Teodora Nisi2, Ottavio Alfieri2. 1. From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.). michele.debonis@hsr.it. 2. From the Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.D.B., E.L., G.L.C., N.B., F.P., M.C., T.N., O.A.); Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland (F.M.); and Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy (F.B.).
Abstract
BACKGROUND: To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). METHODS AND RESULTS: From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). Survival at 12 years was 51.3±7.75%. At the last echocardiographic examination, MR ≥3+ was demonstrated in 33 patients (55%). At 12 years, freedom from reoperation was 57.8±7.21% and freedom from recurrence of MR ≥3+ was 43±7.6%. Residual MR >1+ at hospital discharge was identified as a risk factor for recurrence of MR ≥3+ (hazard ratio, 3.8; 95% confidence interval, 1.7-8.2; P=0.001). In patients with residual MR ≤1+ immediately after surgery, freedom from MR ≥3+ at 5 and 10 years was 80±6% and 64±7.58%, respectively. CONCLUSIONS: In degenerative MR, the overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. Early optimal competence (residual MR ≤1+) was associated with higher freedom from recurrent severe regurgitation.
BACKGROUND: To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). METHODS AND RESULTS: From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). Survival at 12 years was 51.3±7.75%. At the last echocardiographic examination, MR ≥3+ was demonstrated in 33 patients (55%). At 12 years, freedom from reoperation was 57.8±7.21% and freedom from recurrence of MR ≥3+ was 43±7.6%. Residual MR >1+ at hospital discharge was identified as a risk factor for recurrence of MR ≥3+ (hazard ratio, 3.8; 95% confidence interval, 1.7-8.2; P=0.001). In patients with residual MR ≤1+ immediately after surgery, freedom from MR ≥3+ at 5 and 10 years was 80±6% and 64±7.58%, respectively. CONCLUSIONS: In degenerative MR, the overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. Early optimal competence (residual MR ≤1+) was associated with higher freedom from recurrent severe regurgitation.
Authors: Mahboob Ali; Satya S Shreenivas; David N Pratt; Donald R Lynch; Dean J Kereiakes Journal: Circ Cardiovasc Interv Date: 2020-08-06 Impact factor: 6.546
Authors: Pablo Maria Alberto Pomerantzeff; Carlos Manuel de Almeida Brandão; Arlindo Riso; Fabio Biscegli Jatene Journal: Arq Bras Cardiol Date: 2021-09 Impact factor: 2.000
Authors: Rodrigo Estévez-Loureiro; Tomás Benito-González; Carmen Garrote-Coloma; Felipe Fernández-Vázquez; Pablo Avanzas; Miguel Piñón; Isaac Pascual Journal: Ann Transl Med Date: 2020-08