Risk factors of posterior pericardial annuloplasty for isolated posterior leaflet prolapse.
BACKGROUND
Posterior autologous pericardial annuloplasty is an option in mitral valve repair. However, the durability of posterior pericardial annuloplasty remains controversial.


METHODS
From June 1999 to July 2004, 49 patients (18 male and 31 female; mean age, 64 +/- 12 years) with isolated posterior leaflet prolapse received posterior autologous pericardial annuloplasty. Transthoracic echocardiographic examination before the operation, at the time of discharge, and then annually was performed and analyzed.


RESULTS
There was no incidence of in-hospital or late death. Only 1 patient (2.1%) required reoperation. In terms of recurrent mitral regurgitation, 31 patients (64.6%) exhibited grade 0 mitral regurgitation, 7 patients (14.6%) exhibited grade 1, and 9 patients (18.8%) exhibited grade 2, whereas only 1 patient (2.0%) exhibited more than grade 3. In terms of predicting postoperative recurrence of significant mitral regurgitation (> or =grade 2), multivariate Cox analysis demonstrated that marked left atrial dilatation and high fractional shortening were independent risk factors. In 8 of 10 patients significant mitral regurgitation recurred after discharge. In terms of left atrial dimension, no significant reduction was observed in the postdischarge recurrent group, and there was a significant difference of left atrial dimension between the postdischarge recurrent group and the nonrecurrent group at the time of discharge.


CONCLUSIONS
The merits of mitral valve repair using posterior autologous pericardial annuloplasty are attractive. However, its use should be limited in selected patients with isolated posterior leaflet disease, nonenlarged atria, and non-high fractional shortening to maintain the durability of the mitral valve repair.
Matsukuma
Seiji
S
Department of Cardiovascular Surgery, Nagasaki University School of Medicine, Nagasaki, Japan. seiji731@net.nagasaki-u.ac.jp
Eishi
Kiyoyuki
K
Yamachika
Shiro
S
Yamaguchi
Hiroichiro
H
Ariyoshi
Tsuneo
T
Hisata
Youichi
Y
Tanigawa
Kazuyoshi
K
Izumi
Kenta
K
Takai
Hideaki
H
D016279:Atrial Function, Left; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000601:surgery*; D015999:Multivariate Analysis; D010496:Pericardium / Q000637:transplantation*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016277:Ventricular Function, Left