Mitral valve reconstruction in Barlow disease: Long-term echographic results and implications for surgical management

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• 作者：Jé ; rô ; me Jouan ; MD^a ; ^b ; ^{jouanjerome@hotmail.com} ; Alain Berrebi ; MD^a ; ^b ; Sylvain Chauvaud ; MD^a ; ^b ; Philippe Menasché ; MD ; PhD^a ; ^b ; ^c ; Alain Carpentier ; MD ; PhD^a ; ^b ; Jean-No&euml ; l Fabiani ; MD ; PhD^a ; ^b
• 关键词：35 ; 35.4 ; 35.4.1 ; 36.2
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：143
• 期：4_supp_S
• 页码：S17-S20
• 全文大小：110 K

文摘

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lass=""h4"">Objective

Owing to the complexity of the underlying lesions, Barlow disease remains a challenge for surgeons performing mitral valve repair. We aimed to assess whether our most recent results involving several surgeons were comparable with those of a previous experience in which mitral valve repair was performed by a more limited group of surgeons.

lass=""h4"">Methods

From September 2000 to January 2007, 200 patients with Barlow disease (135 men and 65 women; mean age, 56 ¡À 13 years) were referred to our institution for surgical treatment of their mitral regurgitation. We retrospectively analysed the mitral lesions characteristics, the surgical techniques used, and clinical outcomes. Follow-up echocardiograms were biannually reviewed.

lass=""h4"">Results

Lesions comprised annular dilatation, excess tissue, and leaflet prolapse in all cases. The most frequent prolapsed segments were P2 (88.5 % ; n = 177) and A2 (55.5 % ; n = 111). Annular calcifications and restrictive valvular motion were associated in 20 % (n = 40). Repair was feasible in 94.7 % (n = 179/189) of non-redo interventions. Immediate postoperative echocardiography showed residual mitral regurgitation greater than 1+ in 6 cases; these patients were all reoperated on within the next months. Operative mortality was 1.5 % (n = 3). Mean follow-up was 77.5 ¡À 25.6 months. At 8 years postoperatively, overall survival was 88.6 % ¡À 3.1 % , freedom from reintervention was 95.3 % ¡À 1.7 % , and freedom from late recurrent moderate mitral regurgitation (>2+) was 90.2 % ¡À 3.1 %

lass=""h4"">Conclusions

Provided that the fundamental principles of mitral valve reconstruction are respected, the surgical techniques are highly reproducible with good long-term results, similar to those published during the pioneering phase of this surgery.