title: Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes.
abstract: OBJECTIVE
  Residual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair.
  
  
  METHODS
  From April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures. The mean clinical and echocardiographic follow-ups were at 4.1 +/- 2.3 and 3.3 +/- 2.4 years, respectively.
  
  
  RESULTS
  Altogether, 12 patients showed recurrent moderate or severe MR during the follow-up period; and 10 of the 12 patients (83.8%) had recurrent moderate or severe MR within 1.5 years. Causes of early MR recurrence were dehiscence of sutured segments and ineffectiveness of the artificial chords. The rates of freedom from reoperation at 3 and 7 years were 95.3% +/- 2.0% and 91.0% +/- 4.7%, respectively. The rates of freedom from recurrent moderate or severe MR at 3 and 7 years were 90.5% +/- 2.9% and 83.8% +/- 5.9%, respectively.
  
  
  CONCLUSIONS
  The prevention of dehiscence of the sutured segment and reestablishment of coaptation using artificial chords are imperative to maintain the durability of mitral valve repair for patients with degenerative disease.
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Nagasaki University, Nagasaki, Japan. takashiren@yahoo.co.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
authors.forename: Siro
authors.initials: S
authors.lastname: Yamachika
authors.forename: Koji
authors.initials: K
authors.lastname: Hashizume
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamane
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tanigawa
authors.forename: Wataru
authors.initials: W
authors.lastname: Hashimoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Odate
authors.forename: Shun
authors.initials: S
authors.lastname: Nakaji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology; D004696:Endocarditis / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult