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Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse


Seeburger, J; Borger, M A; Doll, N; Walther, T; Passage, J; Falk, V; Mohr, F W (2009). Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. European Journal of Cardio-Thoracic Surgery, 36(3):532-538.

Abstract

OBJECTIVE: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. METHODS: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n=156, 12.7%), isolated PML (n=672, 54.6%) or BL (n=402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3+/-0.8, left ventricular ejection fraction (LVEF) was 62+/-12% and mean age was 58.9+/-13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7+/-2.1 years, and the follow-up was 100% complete. RESULTS: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n=56), atrial fibrillation ablation (n=286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n=89). The overall duration of cardiopulmonary bypass was 127+/-40 min and aortic cross-clamp time was 78+/-33 min. The mean postoperative hospital stay was 11.6+/-9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3+/-0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. CONCLUSIONS: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.

Abstract

OBJECTIVE: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. METHODS: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n=156, 12.7%), isolated PML (n=672, 54.6%) or BL (n=402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3+/-0.8, left ventricular ejection fraction (LVEF) was 62+/-12% and mean age was 58.9+/-13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7+/-2.1 years, and the follow-up was 100% complete. RESULTS: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n=56), atrial fibrillation ablation (n=286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n=89). The overall duration of cardiopulmonary bypass was 127+/-40 min and aortic cross-clamp time was 78+/-33 min. The mean postoperative hospital stay was 11.6+/-9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3+/-0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. CONCLUSIONS: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:24 Nov 2009 16:18
Last Modified:05 Apr 2016 13:33
Publisher:Elsevier
ISSN:1010-7940
Publisher DOI:https://doi.org/10.1016/j.ejcts.2009.03.058
PubMed ID:19464911

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