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[Reconstructive surgery for acquired mitral regurgitation]
S Fukunaga1, S Aoyagi, K Kosuga
1Second Department of Surgery, Kurume University School of Medicine, Japan.
Insights
Mitral valve repair (MVP) shows low operative mortality. While effective for types I and II valve disease, type III mitral regurgitation often requires reoperation, limiting MVP
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Mitral Valve Disease
Context:
- Analysis of 96 patients undergoing mitral valve repair for acquired mitral regurgitation between 1967 and 1994.
- Classification of mitral valve pathology into three types (I, II, III) based on Carpentier's classification.
Purpose:
- To evaluate the long-term outcomes and reoperation rates following mitral valve repair for different types of mitral regurgitation.
- To assess the suitability of mitral valve repair (MVP) for various mitral valve pathologies.
Summary:
- Operative mortality was 1.0%, with no significant difference in late mortality across valve pathology types.
- Thromboembolism occurred at a rate of 0.4% per patient-years.
- Reoperation was required in 28 patients; type II had an 83.2% reoperation-free rate at 20 years, while type III had a 14.8% reoperation-free rate.
Impact:
- Mitral valve repair is a viable option for types I and II mitral regurgitation.
- High reoperation rates for type III mitral regurgitation suggest limited applicability of MVP in these cases.
- Findings guide patient selection for mitral valve repair procedures.
Abstract:
Between December, 1967, and July, 1994, 96 patients underwent repair of the mitral valve for acquired mitral valve regurgitation. According to Carpentier's classification, mitral valve pathology resulting in valve regurgitation was classified into three types; 4 patients assigned to type I, 63 type II, and 29 type III. The operative mortality rate was 1.0%. Follow-up data were available in 95 patients from 0.5 year to 25.3 years (mean average 8.8 years). The late mortality rate were not different between patients with valve pathology of type I, II and those with valve pathology of type III. Thromboembolism occurred on three patients for an embolic rate of 0.4% per patient-years. Twenty-eight patients required reoperation for residual MR and dehiscence of suture lines (type II; 10 cases, reoperation-free rate at 20 years, 83.2%) or recurrent MR due to progression of valve deformity (type III, 18 cases, reoperation-free rate at 20 years, 14.8%). These results demonstrate that patients with type I and II valve are good candidates for MVP, and that high incidence of reoperation for recurrent MR may limit the application of MVP to selected patients with type III valve.