Measured posterior annuloplasty for repair of non-ischemic mitral regurgitation. A single unit follow-up

Abstract

The aim of this report is to evaluate short- and long-term outcomes of annuloplasty method of our choice: measured posterior annuloplasty (MPA). MPA is a piece of a Duran ring cut to the length of free-edge of anterior mitral leaflet (AML) and anchored with multiple pledgeted U-sutures from trigone to trigone into the posterior annulus. Material and methods: From 1988 to 2000, 103 consecutive patients with nonischemic mitral regurgitation were scheduled preoperatively to be repaired by MPA. Results: Preoperative mitral valve regurgitation (MR) grade was 3.8 +/- 0.5 and decreased to 0.1 +/- 0.3 (P < 0.0001) after repair. One patient was converted to insertion of mechanical prosthesis after grade 3 MR persisted after septal myectomy and MPA. Three patients needed instant revision of the repair one due to SAM and two due to stenosis. No patient had a stenosis or unacceptable (> 1) MR after the procedure. There was one operative death (1.0%) and 3 hospital/30-day deaths (2.9%). Sixteen patients (16.3%) expired during the follow-up to 91 months (mean 57.4 +/- 19.5, median 60 months) none due to failure of MPA. There were no reoperations due to failure of MPA. Three patients had a reoperation, one for dehiscence of reconstruction after P2 resection and two patients due to progression of anterior leaflet degeneration and calcification with 4q MR. New York Heart Association (NYHA) functional classification decreased from 2.3 +/- 0.8 to 1.4 +/- 0.6 (P < 0.0001) and only one patient had an increase from II to III. Eighty-eight patients (96.7%) were in NYHA class I-II. Ten patients had an increase of MR from 0 to trace or 1 and one from 0 to 2. Two patients were diagnosed with mild stenosis without need of reoperation. Conclusions: MPA is a durable and stable alternative for repair of non-ischemic mitral regurgitation of different etiologies. The technique gives an objective measure of the length of the band and no patient is left with a significant MR or mitral valve stenosis (MS). First-time success rate is very high and instant repairs few and minor. Freedom of MPA related reoperations is 100%. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.