title: Autologous pericardium annuloplasty: a "physiological" mitral valve repair.
abstract: OBJECTIVE
  Autologous pericardium annuloplasty (APA) is an alternative to prosthetic ring implantation for mitral valve (MV) repair, avoiding the use of foreign material and preserving the mitral annulus' physiological motion. However, data on durability are questionable. Therefore, we analyzed long-term outcomes of treating degenerative mitral regurgitation (MR) with APA.
  
  
  METHODS
  Four hundred ninety patients (mean age, 54.3±11.3 years, [15-77 years]; N.=360 men [74.1%]) who had undergone APA and neochordae implantation between July 1988 and December 2006 were retrospectively studied.
  
  
  RESULTS
  MR was purely degenerative in 434 (89.3%) patients; endocarditis was present in 44 (9.1%) patients; an anterior, posterior, or bileaflet prolapse was present in 32 (6.6%), 241 (49.6%), and 213 (43.8%) patients, respectively. Clinical follow-up was 100% complete at a median of 6.5 years (5th percentile, 0.9; 95th percentile, 14.9) with an echocardiographic study in 92% of patients. In-hospital mortality was 1% (5 deaths); overall and late cardiac mortality were 7.6% and 3.9% (37 and 19 deaths), respectively. Kaplan-Meier curves for overall survival, late cardiac survival, and freedom from reoperation at 15 years (20 cases) were 86% (95%CI 80-91), 93% (95%CI 88-96), and 93% (95%CI 88-96), respectively. At 15 years, freedom from recurrent MR (28 patients) and endocarditis (6 events) were 86% (95%CI 76-91) and 97% (95%CI 92-99). Dehiscence, significant calcification of APA, and hemolysis never occurred. At reoperations, annular pericardium appeared covered by a smooth layer of tissue.
  
  
  CONCLUSIONS
  APA is feasible, safe, and cost-effective, providing long-term durability, high survival, and a low rate of valve-related complications.
authors.affiliation: Cardiac Surgery Division, Santa Maria dei Battuti Hospital, Treviso, Italy - elena.cavarretta@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Salvador
authors.forename: E
authors.initials: E
authors.lastname: Cavarretta
authors.forename: G
authors.initials: G
authors.lastname: Minniti
authors.forename: E
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: V
authors.initials: V
authors.lastname: Salandin
authors.forename: G
authors.initials: G
authors.lastname: Frati
authors.forename: E
authors.initials: E
authors.lastname: Polesel
authors.forename: C
authors.initials: C
authors.lastname: Valfrè
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult