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Published on: December 11, 2017
Reoperative analysis after mitral valve repair with glutaraldehyde-treated autologous pericardium
Naoto Fukunaga1, Ryuzo Sakata1, Tadaaki Koyama1
1Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Objectives:
We reviewed reoperations following mitral valve repair (MVR) that used glutaraldehyde-treated autologous pericardium for mitral regurgitation (MR) to analyse the durability and risk factors for reoperation.
Methods:
We retrospectively analysed 144 patients (mean age 57.9 years) who underwent MVR using glutaraldehyde-treated pericardium from March 1992 to December 2011. A total of 19 reoperations were necessary during the follow-up period (mean 6.9 years). The follow-up rate was 97.8%.
Results:
At initial MVR, there were no differences in mitral leaflet augmentation applied to the anterior or posterior leaflets (P = 0.75 and P = 0.40) in both groups. Reoperations were required in 19 patients, and the mean interval between initial and redo operations was 6.7 years. Indications for reoperation included recurrent MR (n = 8), progressive mitral stenosis (n = 8) and recurrent infective endocarditis (n = 3). The rates of freedom from reoperation at 5, 10 and 15 years were 95.2 ± 1.9%, 83.5 ± 4.8% and 66.9 ± 8.5%, respectively. Four patients underwent redo MVR for recurrent MR, and the remaining 15 patients underwent mitral valve replacement. The freedom from reoperation rate in the group who underwent leaflet augmentation was statistically lower than that in the non-augmentation group (96.9 ± 2.2% vs 93.4 ± 3.2% at 5 years and 89.7 ± 4.5% vs 68.8 ± 13.7% at 10 years; log-rank, P = 0.008). Predictors of reoperation were absence of leaflet augmentation (P = 0.086, hazard ratio = 0.194) and persistent MR (P = 0.003, hazard ratio = 5.759).
Conclusions:
We must regularly pay careful attention to implanted pericardium, especially when augmented, as it constitutes a risk factor for reoperations. In addition, secure MVR is mandatory to control persistent MR.
Insights
Reoperations after mitral valve repair using autologous pericardium are linked to leaflet augmentation and persistent mitral regurgitation. Careful monitoring of implanted pericardium is crucial for long-term durability.
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Surgical Outcomes Research
Background:
- Mitral regurgitation (MR) is a common valvular heart disease.
- Mitral valve repair (MVR) using glutaraldehyde-treated autologous pericardium is a surgical option.
- Durability and reoperation rates following this MVR technique require further investigation.
Purpose of the Study:
- To analyze the durability of mitral valve repair using glutaraldehyde-treated autologous pericardium.
- To identify risk factors associated with reoperation after this MVR procedure.
Main Methods:
- Retrospective analysis of 144 patients undergoing MVR with glutaraldehyde-treated pericardium.
- Follow-up for a mean of 6.9 years, assessing reoperation rates and indications.
- Statistical analysis to determine predictors of reoperation, including leaflet augmentation.
Main Results:
- 19 reoperations were performed over the follow-up period.
- Indications for reoperation included recurrent MR, mitral stenosis, and infective endocarditis.
- Absence of leaflet augmentation and persistent MR were significant predictors of reoperation (P=0.003).
Conclusions:
- Glutaraldehyde-treated autologous pericardium in MVR requires careful monitoring, particularly when augmented.
- Leaflet augmentation was associated with a lower freedom from reoperation rate.
- Effective MVR techniques to prevent persistent MR are essential for long-term success.
