Reparación de la insuficiencia mitral por prolapso del velo posterior. ¿Qué ha cambiado?

Abstract

IntroductionRepair of mitral regurgitation due to posterior leaflet prolapse has evolved in the last 20 years from the classic Carpentier techniques towards less aggressive procedures with the valve tissue. The objective of this study is to describe the evolution of our center in the treatment of this pathology. MethodsRetrospective study of 260 patients with posterior leaflet prolapse operated on our center since 2001, including them into two groups: A (until 2010) and B (since 2011). We collected intraoperative data and echocardiographic and follow-up data for 20 years. Results260 patients operated on in two periods were included: until 2010, 84 patients (group A) and since 2011, 176 patients (group B). The most commonly used techniques in group A were quadrangular resection (51 patients, 60.7%), triangular resection (20 patients, 23.8%), and neochordal implantation (8 patients, 9.5%), with a reparability rate of 98.8% and in group B, triangular resection (86 patients, 48.9%), neochordal implantation (45 patients, 25.6%) and quadrangular resection (28 patients, 15.9%) with a reparability rate of 96.6%. Hospital mortality was 3.6% (n=3) in group A and 0.6% (n=1) in group B. Actuarial survival was 50% at 20 years (A) and 81% at 10 years (B). Reoperation-free rate was 98% (A) and 97.2% (B). Taking into account the most frequently used techniques, the recurrence of mitral regurgitation ≥II was greater in patients with neochordae (n=14, 26.4%) than in cases with quadrangular (n=10, 13.2%) or triangular resection (n=13, 12.4%). ConclusionsOur center has evolved towards techniques with less tissue resection and greater use of neochordae although both techniques have showed excellent long-term results. Resective techniques are more reproducible and durable than neochordal implantation.