Prospective Analysis of 50 Oligosymptomatic Patients with Severe, Structural Mitral Regurgitation, Who Underwent a Procedure of Minimally Invasive Mitral Valve Repair
Witold Gerber1, Agnieszka Drzewiecka-Gerber1, Krzysztof Sanetra1, Małgorzata Świątkiewicz1, Katarzyna Czarnecka2, Justyna Jankowska-Sanetra1, Marek Cisowski1.
1American Heart of Poland, Bielsko-Biała, Poland, 2Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.
OBJECTIVE: The objective of this study is to determine whether patients with oligosymtomatic, structural mitral valve insufficiency may benefit from mini-invasive mitral valve repair with right thoracotomy approach.
METHODS: A group of 50 patients, who underwent mini-invasive mitral valve repair with right thoracotomy approach was included in this prospective study. ESC/EACTS 2012 echocardiographic criteria for the definition of severe mitral valve regurgitation were presented in all cases, clinically patients were in class NYHA I and II. Detailed echocardiography examination was performed as well as assessment of certain clinical parameters was done during one and six months observation.
RESULTS: At baseline, 74% patients were in NYHA class I and 26% patients were in NYHA class II. Euroscore was 3,2±2,2. The patients underwent mitral valve repair with annuloplasty ring and other interventions such as: implantation of artificial chordae(76%), resection of P2(18%), correction of clefts(8%), additional radiofrequency ablation(8%), closure of left atrial appendage(14%) and closure of PFO(10%). Mean aortic cross-clamp time was 83±17,6 minutes and mean extracorporeal circulation time was 120,8±25 minutes.
None of patients died during entire observation time. In perioperative period, 12% patients had arrhythmia that resolved spontaneously or after pharmacotherapy. One patient required electrical cardioversion. Six patients had thoracentesis, three underwent surgical thorax revision due to surgical bleeding. Mean total in-hospital stay was 7,5 ±1,7 days.
Six month observation complications were: thoracentesis in four patients, mild cerebral infarction in one patient, reoperation due to endocarditis in one patients, pericarditis in one patient. At six month follow-up nine patients maintained without pharmacotherapy, nine required only small dose of B-bloker. Clinically 98% of patients were in NYHA class I and II. Mild mitral regurgitation was observed in three patients, in two cases total regression of regurgitant jet was observed after correction of hypertensive therapy. Echocardiographic evaluation is presented in tab.1.
CONCLUSIONS: Mini-invasive mitral valve surgery should be considered in oligosymptomatic patients as it is safe, highly successful method that significantly improves echocardiographic and clinical parameters in 6-month observation
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