title: Current strategies of mitral valve repair.
abstract: BACKGROUND
  During the last decade new surgical techniques for mitral valve repair were developed. We have been using those techniques in order to widen the spectrum of patients eligible for MV repair.
  
  
  OBJECTIVE
  To assess the operative and mid-term results a wide variety of surgical techniques.
  
  
  METHODS
  From January 2004 through December 2006, 213 patients underwent MV repair in our institution. Valve pathology was degenerative in 123 patients (58%), ischemic in 37 (17%), showed annular dilatation in 25 (12%), endocarditis in 16 (8%), was rheumatic in 13 (6%), and due to other causes in 14 (7%). Preoperative New York Heart Association score was 2.35 +/- 0.85 and ejection fraction 53 +/- 12%. Isolated MV repair was performed in 90 patients (42%) and 158 concomitant procedures were done in 123 patients (58%). A wide variety of surgical techniques was used in order to increase the number of repairs compared to valve replacement.
  
  
  RESULTS
  There were 7 in-hospital deaths (3.3%). NYHA class improved from 2.19 +/- 0.85 to 1.4 +/- 0.6, and freedom from reoperation was 100%. Echocardiography follow-up of patients with degenerative MV revealed that 93% of the patients (115/123) were free of mitral regurgitation greater than 2+ grade. In patients operated by a minimal invasive approach there were no conversions to stemotomy, no late deaths, none required reoperation, and 96% were free of MR greater than 2+ grade. The use of multiple surgical techniques enabled the repair of more than 80% of pure MR cases.
  
  
  CONCLUSIONS
  MV repair provides good perioperative and mid-term results, and supports the preference for MV repair over replacement, when feasible. Multiple valve repair techniques tailored to different pathologies increases the feasibility of mitral repair.
authors.affiliation: Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel. danny.spiegelestein@gmail.com
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstein
authors.forename: Probal
authors.initials: P
authors.lastname: Ghosh
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.forename: Salis
authors.initials: S
authors.lastname: Tager
authors.forename: Amihai
authors.initials: A
authors.lastname: Shinfeld
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000592:standards*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome