Resultados de la reparación mitral en función de la etiología: 15 años de seguimiento

Abstract

BackgroundEtiology and other factors may influence the outcomes of mitral valve repair. We have analyzed survival and durability in a variety of etiologies. Material and Methods406 patients underwent mitral valve repair (1997–2011) with ages between 19–84 years. 156 were females (38.4%). 57.1% patients were in NYHA class III-IV. 5 groups were considered: degenerative (group-D), 203; ischemic (group-I), 90; functional (non-ischemic) (group-F), 19; rheumatic (group-R), 61 and endocarditis (group-E), 33 patients. Undersized annuloplasty was used in ischemic and functional groups. Quadrangular resection and neochordal repair were predominant in case of degenerative etiology whereas a variety of resective and reconstructive techniques were used in rheumatic and endocarditis groups. Results30-day mortality was 4.4%: 3.4%, 4.4%, 0%, 6.6% and 10% in respective groups. 5 and 10-year survival: 86±1% and 70±4%. Long-term mortality was higher in groups F and I (31.6% and 20%) compared with 12.3%, 11.5% and 13.3% in groups D, R and E. Group-D had higher durability and freedom from grade 3–4/4 mitral regurgitation than non-degenerative groups: 86±2 vs 84±2% (p=0.46) at 5 years and 82±3 vs 54±1% (p=0.02) at later follow-up. Group-R was associated with recurrent grade-3 and grade-4 mitral regurgitation (OR: 1.98, 95%-CI: 1.01–3.89; p=0.05 and OR: 3.31, 95%-CI: 1.17–9.32; p=0.02). 14 patients underwent mitral valve replacement: 3, 1, 1, 6 and 3. ConclusionsThe outcomes of mitral valve repair were successful. Survival, recurrence rate and reoperation were excellent in group-D. Rheumatic regurgitation had shorter durability and functional mitral regurgitation had lower survival.