Severe calcification does not affect long-term outcome of mitral valve repair.
Some surgeons have suggested that the presence of severe calcification in the mitral valve annulus or leaflets precludes successful repair. Our institution has attempted to repair these calcified valves when good annular and leaflet mobility could be achieved by annular debridement and leaflet resection. From June 1979 through June 1993 558 mitral valve repairs were performed using Carpentier's techniques. When calcified valves were encountered, these techniques were modified to include annular debridement and mechanical leaflet decalcification. Calcification was identified preoperatively in 49 patients (8.8%) by either left ventricular fluoroscopy or echocardiography and was debrided in 64 patients (11.5%). This included 24 annular debridements, 28 leaflet debridements, and 12 annular and leaflet debridements. Patient ages ranged from 13 to 83 years (mean age, 62.3 years), and 25 patients (39.1%, 25/64) had concomitant cardiac procedures. Operative mortality was 6.2% (4/64) overall and 2.6% (1/39) for isolated mitral valve repairs. Calcium debridement was performed in 19.3% (23/119) of patients with a rheumatic cause compared with 9.3% (41/439) of the nonrheumatic patients (p < 0.01). Long-term follow-up revealed the necessity for reoperation in 7.8% (5/64) in patients with calcium debridement as compared with 7.7% (38/494) with no debridement (p = not significant). Cumulative freedom from reoperation at 10 years was 83.3% for all patients, 88.1% for debrided patients, and 82.6% for nondebrided patients (p = not significant). Cox proportional hazards analysis revealed that the presence of rheumatic disease significantly increased the risk of reoperation (odds ratio = 3.28; p < 0.001), whereas calcium debridement had no significant effect. These results demonstrate that when good annulus and leaflet motion can be achieved in calcified mitral valves, calcium debridement allows durable repairs.
Grossi
E A
EA
Department of Surgery, New York University Medical Center, New York 10016.
Galloway
A C
AC
Steinberg
B M
BM
LeBoutillier
M
M
Delianides
J
J
Baumann
F G
FG
Spencer
F C
FC
Colvin
S B
SB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003646:Debridement; D004452:Echocardiography; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000150:complications; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome