title: Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients.
abstract: BACKGROUND
  American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation.
  
  
  METHODS
  We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms.
  
  
  RESULTS
  In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear.
  
  
  CONCLUSIONS
  We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: levi.bassin@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Bassin
authors.affiliation: Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Department of Cardiology, The Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Cranney
authors.affiliation: School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Gimpel
authors.affiliation: School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Gilhooly
authors.affiliation: School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Smith
authors.affiliation: Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Akhunji
authors.affiliation: Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Grant
authors.affiliation: Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Wolfenden
mesh_terms: D000368:Aged; D004452:Echocardiography; D006801:Humans; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control*
keywords: Cardiac Surgery; Mitral valve; Valve repair