title: Unsupported valvuloplasty for degenerative mitral regurgitation: long-term results.
abstract: BACKGROUND
  The advantages of valve repair for treatment of degenerative mitral regurgitation are well established. The procedure is associated with low mortality and morbidity rates, and low indices of reoperation, thromboembolic events and endocarditis have been reported. In most series, annuloplasty rings are implanted, but some institutions give preference to unsupported valvuloplasty.
  
  
  OBJECTIVE
  To assess the clinical outcome of patients submitted to unsupported valvuloplasty for degenerative mitral regurgitation.
  
  
  METHODS
  Between January 1980 and January 2003, 116 patients were submitted to the procedure. A total of 62 (53.4%) were men, and mean age was 47.2 +/- 16.5 years. The procedures included: Wooler annuloplasty (65.5%), unilateral annuloplasty (15.5%), quadrangular resection of the posterior leaflet (35.3%), anterior chordal shortening (20.7%), posterior chordal shortening (6.9%), and calcium debridement (0.9%). Mean follow-up was 6.5 +/- 5.1 years, and the longest follow-up was 24 years.
  
  
  RESULTS
  Mortality was 0.86% (1 pt) early and 6.03% (7 pt) late. Actuarial survival was 85.3% in 20 years. Most patients (55.2%) presented preoperative NYHA functional class III, whereas class I was more frequent in the postoperative period (66.4%). Thromboembolic complications were observed in 4 patients (3.4%), and no correlation was seen with atrial fibrillation. Freedom from thromboembolic events was 94.8%, and similar results were observed for bacterial endocarditis. Survival free from reoperation was 79%, and 53% at 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  Unsupported valvuloplasty is effective and safe for treatment of degenerative mitral regurgitation, representing an adequate therapeutic alternative for selected cases.
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS - Brasil.
authors.forename: Alexsandra L
authors.initials: AL
authors.lastname: Balbinot
authors.forename: Renato A K
authors.initials: RA
authors.lastname: Kalil
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Prates
authors.forename: João Ricardo M
authors.initials: JR
authors.lastname: Sant'Anna
authors.forename: Orlando C
authors.initials: OC
authors.lastname: Wender
authors.forename: Guaracy Fernandes
authors.initials: GF
authors.lastname: Teixeira Filho
authors.forename: Rogério S
authors.initials: RS
authors.lastname: Abrahão
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Nesralla
mesh_terms: D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome