Clinical outcomes of mitral valve repair: a single-center experience in 100 patients

Abstract

Amac: Calismamizda mitral yetersizlik (MY) ve mitral darlik icin uygulanan kapak tamirlerinin klinik sonuclari degerlendirildi. Ca­lis­ma­ pla­ni:­ Bu klinik calismaya, mitral tamir uygulanan ardisik ilk 100 hasta (46 erkek, 54 kadin; ort. yas 52.1±15.5 yil; dagilim 16-77 yil) dahil edildi. Patolojiler romatizmal (n=44), iskemik (n=30), miksomatoz (n=29) ve korda rupturu (n=7) idi. Mitral anuloplasti halkasi rutin olarak kullanildi. Hastalarin %79’una es zamanli islemler uygulandi; koroner arter baypas greftleme (n=35) ve trikuspid halka anuloplasti (n=34). Ameliyat sonrasi komplikasyonlar kaydedildi. Ekokardiyografik incelemeler taburcu sirasinda ve klinik takip surecinde yapildi. Kaplan-Meier analizi genel sagkalim ve reziduel ciddi MY, tromboembolizasyon, endokardit ve tekrar ameliyatsiz sagkalim oranlarinin tahmininde kullanildi. Bul gu lar: Dusuk kardiyak debi ve sepsis nedeniyle bes hastada erken (30 gun) mortalite gelisti. Taburculuk sirasinda ekokardiyografi ile hastalarin %59.5’inde eser/hic MY, %30.8’inde hafif MY ve %5.3’unde orta MY saptandi. Ortalama takip suresi, 94 hasta icin 22.7±5.8 aydi. Takip doneminde transtorasik ekokardiyografide %96.6 hastada hafif MY izlendi. Sadece iki hastada (%2.1) endokardit ve iskemiye bagli ciddi MY saptandi. Ortalama sol ventrikul sistol (p=0.01) ve diyastol sonu (p<0.05) caplarinda ameliyat sonrasinda azalma goruldu. Kaplan-Meier analizi ile sagkalim, reziduel ciddi MY, tromboembolizasyon, endokardit, MY nuksu ve tekrar ameliyatsiz sagkalim oranlari ameliyat sonrasi 30 ay icin sirasiyla; %94.0±2.3, %96.9±2.2, %98.4±1.5, %98.9±1.1, %96.9±2.2 ve %98.9±1.1 idi. So­nuc:­ Mitral kapak tamiri farkli kapak patolojileri ve karmasik lezyonlarin tedavisinde basarili ve etkin bir yontemdir. Anah tar soz cuk ler: Mitral yetersizlik; mitral darlik; mitral kapak tamiri; mitral kapak. Background:­ In this study, we evaluated the clinical outcomes of valve repair for mitral regurgitation (MR) and mitral stenosis. Methods: This clinical study included the first 100 consecutive patients (46 males, 54 females; mean age 52.1±15.5 years; range 16 to 77 years) who underwent mitral repair. Pathologies were rheumatic (n=44), ischemic (n=30), myxomatous (n=29), and chordal rupture (n=7). Mitral annuloplasty ring was used routinely. Concomitant procedures were performed in 79% of patients including coronary artery bypass grafting (n=35) and tricuspid ring annuloplasty (n=34). Postoperative complications were recorded. Echocardiographic examinations were performed at discharge and during follow-up. KaplanMeier analysis was used to estimate overall survival and from residual severe MR, thromboembolization, endocarditis and reoperation-free survival rates. Results:­Early (30 days) mortality developed in five patients due to low cardiac output and sepsis. At discharge, echocardiography revealed none/trivial MR in 59.5%, mild MR in 30.8%, and moderate MR in 5.3% of patients. The mean follow-up was 22.7±5.8 months in 94 patients. During follow-up, transthoracic echocardiography showed mild MR in 96.6% patients. Only two patients (2.1%) presented with severe MR due to endocarditis and ischemic disease. The mean left ventricular end-systolic (p=0.01) and end-diastolic diameters (p<0.05) decreased postoperatively. Kaplan-Meier estimates showed that death, severe MR, thromboembolization, endocarditis, MR recurrence and reoperation-free survival rates were 94.0±2.3%, 96.9±2.2%, 98.4±1.5%, 98.9±1.1%, 96.9±2.2%, and 98.9±1.1% at postoperative 30 months, respectively. Conclusion:­ Mitral repair is a successful and effective procedure in the treatment of distinct mitral valve pathologies and complex lesions.