[Quality parameters in mitral valve surgery].
Quality criteria comprise indication, perioperative results and complications as well as long-term stability Indication for surgery on asymptomatic mitral incompetence is still debated. The higher the probability within an institution to repair the valve by surgery with minimal complications, the more asymptomatic patients could be considered for early surgery. A thorough quality criterion is the percentage of valve repair in pure mitral incompetence. In Germany the rate is about 60%, but may be increased to about 90%. One prerequisite is the exact interpretation of the preoperative echocardiogram by the surgeon to be able to plan the optimal strategy for the individual patient. Recognition of even discrete subaortic hypertrophy as well as the consideration that any ring implant causes some degree of restriction of both leaflets may improve the technical results. Mortality for isolated mitral valve repair should not exceed 3%, neurologic complication should range between 1% and 1.5%. Reoperation rate within 10 year follow-up should not be higher than 4 - 6%. Surgical results after mitral valve replacement are inferior as this therapy is usually restricted to patients with more complex valve disease for primarily increased perioperative risk. Preservation of the subvalvular apparatus and the optimal orientation of implanted valve prosthesis are relevant intraoperative surgical quality criteria. Mitral valve surgery can be performed with a high rate of valve preservation. A relevant reduction of mortality and perioperative morbidity and improved long term stability could be achieved during the last years.
Moritz
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Klinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum der Johann Wolfgang Goethe-Universität Frankfurt. Anton.moritz@kgu.de
D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011300:Preoperative Care / Q000592:standards; D011475:Prosthesis Failure; D011785:Quality Assurance, Health Care; D012086:Reoperation / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome