Trends in mitral valve surgery: a single practice experience.
OBJECTIVE
Mitral repair has evolved to a point where three methods can be used to address most pathologies: full ring annuloplasty (RA) for annular disease; Gore-Tex artificial chordal replacement (ACR) for chordal disease; and autologous pericardial augmentation (PA) for leaflet disease. The study aim was to assess the impact of the increasing application of these methods on operative results over time.


METHODS
Of 328 consecutive mitral valve procedures, 34% involved myxomatous prolapse, 23% rheumatic, 13% ischemic, 12% pure annular dilatation, 7% prosthetic dysfunction, 6% endocarditis, 3% hypertrophic obstructive cardiomyopathy (HOCM), and 2% 'other'. All patients underwent RA. Myxomatous prolapse was repaired with ACR, and ischemic and annular dilatation with RA alone. Rheumatic, endocarditis, and HOCM etiologies were repaired with all three methods. Patients were allocated to two-year increments, and also to repair versus replacement groups. Operative outcomes over time were assessed with linear and binomial regression.


RESULTS
Overall, 66% of mitral valves were repaired; the average operative mortality was 6% (2% for repair, 7% for replacement), and 18% involved multiple valve procedures (mortality 16%). The extent of repair increased over time, from 55% to 100% of all etiologies. Over the same period, operative mortality fell from 6% in 1994 to 0% over the past six years. Other variables, such as age, presentation status, left ventricular dysfunction and etiology were relatively constant over the period. Reoperation rates after repair have been only 2% over the past 10 years of follow up.


CONCLUSIONS
With recent innovations, most mitral disease can be repaired with combinations of RA, ACR and PA. Today, operative mortality is approaching zero, and one factor may be the increasing application of repair to all mitral pathologies. These data support the trend of expanding valve repair across most mitral disorders.
Centennial Medical Center and Vanderbilt University, Nashville, TN, USA. jsrankinmd@cs.com
J Scott
JS
Rankin
Calvin A
CA
Burrichter
Melissa K
MK
Walton-Shirley
James H
JH
Whiteside
Stephen M
SM
Teague
Victor W
VW
McLaughlin
Mukesh K
MK
Sharma
Thomas S
TS
Johnston
A Thomas
AT
McRae
Paul R
PR
Myers
D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality / Q000639:trends*; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States