Results of mitral valve annuloplasty with a standard-sized posterior band: Is measuring important?

Objective This study was undertaken to determine hemodynamic and clinical outcomes of annuloplasty with a standard-sized (63 mm) posterior band in adult patients undergoing mitral valve repair for degenerative valve disease. Methods We studied 511 patients who underwent isolated mitral valve repair...

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Published in:The Journal of thoracic and cardiovascular surgery 2009-10, Vol.138 (4), p.886-891
Main Authors: Brown, Morgan L., MD, Schaff, Hartzell V., MD, Li, Zhuo, MS, Suri, Rakesh M., MD, Daly, Richard C., MD, Orszulak, Thomas A., MD
Format: Article
Language:English
Subjects:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiology. Vascular system
Cardiothoracic Surgery
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Medical sciences
Middle Aged
Mitral Valve - diagnostic imaging
Mitral Valve - surgery
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - physiopathology
Mitral Valve Insufficiency - surgery
Pneumology
Stroke Volume
Ultrasonography
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Summary:Objective This study was undertaken to determine hemodynamic and clinical outcomes of annuloplasty with a standard-sized (63 mm) posterior band in adult patients undergoing mitral valve repair for degenerative valve disease. Methods We studied 511 patients who underwent isolated mitral valve repair for degenerative disease with a 63-mm posterior band used for annuloplasty. Operations were performed between 1994 and 2001, and average follow-up was 4.8 ± 3.1 years. Echocardiographic data were reviewed, with specific focus on the relationship between patient size and residual mitral regurgitation and gradient. Results Mean age at the time of operation was 59.3 ± 13.5 years, and 72% were male. Body mass index was 25.8 ± 4.1 kg/m2 , and body surface area was 1.97 ± 0.24 m2 . Preoperative mean ejection fraction was 64% ± 7%, and 96% of patients had severe mitral regurgitation on preoperative echocardiography. The 30-day mortality was 0.8%. At hospital discharge, the mean gradient was 4.7 ± 3.1 mm Hg. Body surface area, body mass index, and weight were not associated with postoperative gradients or residual regurgitation at discharge. At last follow-up, 89% of patients had no or mild regurgitation, and the mean ejection fraction was 58% ± 9%. At 5 years, survival was 95% and cumulative risk of reoperation was 3%. Conclusion A standard-sized (unmeasured) posterior annuloplasty band provided excellent intermediate results with good durability. There were neither excess gradients in larger patients nor excess regurgitation in smaller patients. Measured annuloplasty is unnecessary for most adults undergoing mitral valve repair.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2009.01.022