Reparación de la insuficiencia mitral funcional mediante abordaje del aparato subvalvular. Resultados a medio plazo

Abstract

Introduction and objectivesSurgical treatment of functional mitral regurgitation still remains an issue widely debated due to its high morbidity and mortality and the absence of consensus about the best therapeutic option (repair vs replacement). We present our mid-term experience in its treatment with a repair approaching de subvalvular apparatus. MethodsBetween 2012 and 2016, 16 patients were operated on in our hospital with a moderate to severe mitral regurgitation due to a Carpentier's type IIIb mechanism. The mean logistic EuroSCORE was 10.81%. In all of them a restrictive ring annuloplasty was carried out, along with the relocation of the posteromedial papillary muscle in 14 patients and the approximation of the papillary muscles in 2 patients. Other procedures were carried out in 12 of these 16 patients. ResultsThe mean follow up period was 29.5 months. There were 2 perioperative deaths. There were no more deaths during the follow up. The recurrence of mitral regurgitation > 2 was 12.5% (2 patients). Only these 2 patients with a mitral regurgitation > 2 in the follow up echocardiograms needed hospital readmission at some point due to decompensated heart failure, remaining the rest of them in NYHA class i-ii/iv. ConclusionsApproaching the subvalvular apparatus in the repair of functional mitral regurgitation seems to be a valuable option in the treatment of this kind of regurgitation, offering optimal results in terms of survival at discharge and in recurrence at mid-term follow up.