Initial Experience Implementing a Mitral Plasty Program: Is It a Technique with Reproducible Results?

Abstract

Background: Repairing the mitral valve has demonstrated a significant advantage over managing severe mitral insufficiency over mitral valve replacement. Therefore, the clinical practice guidelines considered it the first therapeutic option for treating valvular pathologies. Consequently, it should be widely adopted as a standard procedure by cardiac surgeons worldwide. Objective: To establish the reproducibility of mitral valve repair within our hospital in terms of techniques and outcomes, we aim to compare our performance with data published by leading international medical institutions. This comparative analysis will allow us to evaluate our proficiency and quality of care in the field of mitral valve surgery in line with global standards. Methods: Between January 2018 and January 2022, 63 patients with severe mitral insufficiency due to degenerative or functional disease who met surgical criteria were operated at Luis Vernaza Hospital. Of these, 22 patients underwent mitral valve repair. We conducted a retrospective longitudinal study and assessed the postoperative progression, focusing on key outcomes, including valve patency, reintervention rates, and mortality. The patients’ follow-up was made by telephone communication, and they underwent at least one annual echocardiogram as a part of the monitoring process. Results: As a result, 22 patients (73% males) with an average age of 48 years (ranging from 36 to 72 years) were analyzed. All patients presented severe mitral insufficiency, with 91% of cases attributed to primary etiology. In our experience, severe primary mitral insufficiency was successfully repaired in 55% of cases, with the P2 segment involvement being the most common cause. On the other hand, only two patients required reoperation, one due to ring dehiscence and the other due to rupture of new chordae tendineae. In contrast, we had one case of hospital mortality associated with immediate reoperation due to repair failure, and three patients passed away later due to non-cardiovascular causes. Finally, the remaining patients are asymptomatic, maintain regular activities, have no residual mitral insufficiency, and maintain a left ventricular function with more than 45% ejection fraction. Conclusion: Mitral valve repair with an annuloplasty ring is a technique that can be successfully replicated in our hospital and provided by cardiac surgeons with adequate training. This approach yields outcomes similar to those achieved in globally renowned centers with higher surgical volumes and extensive experience in mitral valve repairs.