ASSA13-08-9 Six Years‘ Experience with Continuous Suture Annuloplasty For Nonischemic Aetiology Mitral Valve Repair

Abstract

Objective The aim of this study was to assess the durability of the continuous suture annuloplasty for nonischemic aetiology mitral valve repair and find out predictors of residual mitral regurgitation in the early postoperative period and its progression at the long-term period. Methods Between 2007 and 2012, 129 elective consecutive patients (58.1% males; age, 55 ± 12 years) underwent simple or complex mitral valve repair. For correction of annular dilatation, we used double-running 2–0 «Ethibond ® » sutures to reduce and reinforce the posterior circumference of the annulus. Patients were investigated prospectively by means of transthoracic echocardiography before discharge and 1 and 3 years after the operation. The mean follow up was 38 ± 15 months (range 8–72 months). Results The operative mortality was 0.0%. Transthoracic echocardiography evaluation at 1 and 3 years showed acceptable mean transvalvular gradients (3.9 ± 1.5 and 4.0 ± 1.3 mm Hg, respectively) and absence of progression of annular dilatation 27.7 ± 3.3 at 1 year and 27.8 ± 3.6 mm at 3 years. Freedom from nontrivial residual mitral regurgitation was 86%, freedom from reoperation was 94% and actuarial survival was 94%, all at 72 months. Patients with residual mitral regurgitation had preoperative left atrium size more than 60 mm, left ventricle end-diastolic size and volume > 64 mm and 220 ml, respectively. Another two predictors were mitral annulus size more than 28 mm after correction and anterior leaflet prolapse. In patients with raised degree of mitral insufficiency at the long-term period, leaflets and chords structural changes progression were registered. Conclusions The midterm results show satisfactory hemodynamic performance and absence of mitral regurgitation progression due to annular redilatation. Valve competence and reoperation rates are comparable with those of other reports. Predictors for residual mitral regurgitation were preoperative size and volume of left chambers, degree of mitral annulus reduction and anterior leaflet prolapse. The main reason for mitral insufficiency at the long-term period was leaflets and chords structural changes progression.