title: Mitral valve repair for degenerative disease: is pericardial posterior annuloplasty a durable option?
abstract: OBJECTIVE
  Biological and prosthetic rings are available for supporting mitral valve repair (MVR). Contrasting data are reported on the durability of pericardial ring annuloplasty. This retrospective study was undertaken to assess the durability of MVR for degenerative regurgitation with posterior annuloplasty performed with glutaraldehyde-treated autologous pericardium.
  
  
  METHODS
  From August 1995 through December 2000, 133 patients underwent mitral repair for degenerative regurgitation (86 men, age 62.9+/-11.5 years). Thirty patients (22.6%) underwent combined coronary artery bypass graft and fourteen (10.5%) underwent tricuspid annuloplasty. Associated aortic disease, previous cardiac surgery and endocarditis were considered exclusion criteria.
  
  
  RESULTS
  Seventy-seven patients (57.9%) received a Carpentier-Edwards ring and 56 received (42.1%) an autologous pericardium ring. Thirty-day mortality was 3.8%. Mean follow-up, 98.3% complete, was of 35.6+/-18.7 months. Five-year freedom from reoperation and recurrence of mitral regurgitation> or =3+/4+ was significantly higher in the prosthetic ring group (90.1% - CL90%: 81.9-98.3%) compared with the pericardial ring group (62.6% - CL90%: 43.1-82.1%; P=0.027). Prosthetic ring implantation (P=0.004; RR=0.11) and preoperative New York Heart Association (NYHA) class< or =II (P=0.011; RR=0.16) were independently related to a lower risk of reoperation and recurrence of mitral regurgitation> or =3+/4+, by multivariate analysis. Five-year overall survival was 91.4% (CL90%: 87.9.7-95%). A higher preoperative left ventricular end-diastolic diameter (P=0.006; RR=1.17) and the severity of associated coronary artery disease (P=0.021; RR=2.00) were independent predictive factors for poor survival by multivariate analysis.
  
  
  CONCLUSIONS
  Posterior pericardial annuloplasty can jeopardize reproducibility and durability of MVR for degenerative regurgitation.
authors.affiliation: Cardiac Surgery Department, National Research Council, Ospedale G. Pasquinucci CNR-CREAS, Massa, Italy. bevilacqua@ifc.cnr.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Alfredo Giuseppe
authors.initials: AG
authors.lastname: Cerillo
authors.forename: Jacopo
authors.initials: J
authors.lastname: Gianetti
authors.forename: Umberto
authors.initials: U
authors.lastname: Paradossi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mariani
authors.forename: Sacha
authors.initials: S
authors.lastname: Matteucci
authors.forename: Enkel
authors.initials: E
authors.lastname: Kallushi
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000368:Aged; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome