title: Late outcome of unsupported annuloplasty for rheumatic mitral regurgitation.
abstract: OBJECTIVE
  The aim of this study was to evaluate medium- and long-term (range 4 months to 17 years) clinical results in a series of patients treated surgically by unsupported mitral annuloplasty.
  
  
  BACKGROUND
  Mitral valve regurgitation has usually been treated by valve replacement or ring annuloplasty. A few series have reported plastic repair procedures without annular support or remodeling. Furthermore, in rheumatic lesions the results have been inferior to those in degenerative mitral insufficiency, and the majority of previous reports have provided information on short- or medium-term follow-up.
  
  
  METHODS
  One hundred fifty-four patients were operated on (55 male [36%] and 99 female [64%]). The mean age +/- SD was 36 +/- 16 years (range 5 to 73). Associated lesions comprised 47 aortic and 21 tricuspid valve lesions and 2 atrial septal defects. Patients with concomitant mitral stenosis were not included. Preoperative functional class was I or II in 19% and III or IV in 81%. The cardiothoracic ratio was 0.61 +/- 0.10. All patients underwent an unsupported mitral annuloplasty procedure in which the mural portion of the annulus was reduced by applying two buttressed mattress sutures at the commissures without compromising the width of the septal leaflet. When necessary, additional chordal procedures were performed. No patients received ring or posterior annular support.
  
  
  RESULTS
  The early mortality rate was 1.9% (three patients; one of the three died of myocardial failure and two of pulmonary thromboembolism). The late mortality rate was 5.8% (nine patients; three of the nine died of myocardial failure, one each of septicemia, pulmonary thromboembolism and sudden arrhythmic death and three of unknown causes). Twenty-eight patients (18.2%) were reoperated on because of mitral valve dysfunction and 2 (1.3%) because of prosthetic aortic valve dysfunction. A residual late systolic murmur was present in 48% of patients. Late complications were systemic thromboembolism in 5.8% (one third with an aortic valve prosthesis), infective endocarditis in 1.3% and pulmonary thromboembolism in 0.6%. Postoperative functional class was I or II in 84% and III or IV in 16%. Cardiothoracic ratio was 0.58 +/- 0.10. Actuarial probability of late survival was 79.5 +/- 5.3% at 10 years and 71.0 +/- 7.4% at 14 years. Event-free survival was 67.9 +/- 8.9% at 10 years and 56.1 +/- 11.7% at 14 years.
  
  
  CONCLUSIONS
  Rheumatic mitral regurgitation can be effectively treated by annuloplasty without prosthetic annular support, with late results comparable to those obtained with more complicated procedures. This observation is particularly important for treatment of children and young adult patients.
authors.affiliation: Department of Surgery, Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Kalil
authors.forename: F A
authors.initials: FA
authors.lastname: Lucchese
authors.forename: P R
authors.initials: PR
authors.lastname: Prates
authors.forename: J R
authors.initials: JR
authors.lastname: Sant'Anna
authors.forename: F C
authors.initials: FC
authors.lastname: Faes
authors.forename: E
authors.initials: E
authors.lastname: Pereira
authors.forename: I A
authors.initials: IA
authors.lastname: Nesralla
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome