Impact of intraoperative echocardiography/surgery team on successful mitral valve repair: a community hospital experience.
OBJECTIVE
Mitral valve (MV) repair is generally accepted as the preferred treatment of mitral regurgitation (MR) with MV prolapse secondary to myxomatous mitral valve disease (MMVD). However, the incidence of successful valve repair is variable between hospitals and among different surgeons at one hospital, and often results in needless MV replacement. The study aim was to measure the impact of a dedicated echocardiography/surgery team on MV repair at a community hospital.


METHODS
The outcome was analyzed of a group of 116 consecutive patients with severe MR secondary to MMVD who underwent surgery by the same surgeon over a six-year period. A dedicated team approach, comprising one echocardiographer and one surgeon was established in January 1999. The results of MV repair between 1996 and 1998 (group I; n = 37) were compared to results obtained between 1999 and 2001 (group II; n = 79).


RESULTS
In group I, MV repair was attempted in 25 patients (67.6%) and was successful in 21 (56.8%). In group II, MV repair was attempted in 68 patients (86.1%) and was successful in 67 (84.8%). The success rate between groups was significantly (p = 0.001) different. The rate of successful MV repair in patients with a diffusely redundant prolapsing valve involving both leaflets and multiple segments with chordae elongation was significantly higher in group II (14/20; 70%) than in group I (1/6; 14.3%) (p = 0.011).


CONCLUSIONS
A greater incidence of successful MV repair, even with more diffuse pathology of MMVD, was realized following the institution of dedicated echocardiography/surgery team at a community hospital. It is proposed that a combination of dedicated intraoperative echocardiography and surgical expertise is required for optimal results in MV repair.
Hoag Heart and Vascular Institute, Newport Beach, CA 92658-6100, USA.
Akira
A
Matsunaga
Pravin M
PM
Shah
Aidan A
AA
Raney
D000368:Aged; D002815:Chordae Tendineae / Q000473:pathology / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006764:Hospitals, Community; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D010348:Patient Care Team; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional