Long Term Results Of Mitral Valve Repair Of Posterior Or Bileaflet Prolapse With Two Different Concepts
Ibrahim M. Yassin1, Farouk M. Oueida2, Mustafa Al Refaei3, Khaled A. Eskander2.
1Cardio-Thoracic Surgery Department, Tanta University, Tanta, Egypt, 2Cardiac Surgery Department,Saud al-Babtin Cardiac Center SBCC, AL DAMMAM, Saudi Arabia, 3Cardiology Department,Saud al-Babtin Cardiac Center SBCC, AL DAMMAM, Saudi Arabia.
OBJECTIVE: Rather than the successful operative results of the mitral valve repair, the long term outcome remains the corner stone of selection of the suitable technique. We sought to evaluate the results of two simple techniques we are using for correction of posterior or bileaflet prolapse with no incidence of postoperative systolic anterior motion of the anterior mitral leaflet (SAM) and excellent operative results.
METHODS: From June 2010 to June 2016, 64 patients with isolated posterior leaflet prolapse (n =23) or bileaflet prolapse (n =41) with or without chordal rupture underwent mitral valve repair. Edge to edge, our initially preferred technique, used in 35 patients (group A) was compared to the newly developed Uniscallop (‘‘U’’) technique, used in 29 patients (group U). In both groups, the annulus was reshaped using a 3D ring annuloplasty (30-32mm). Postoperative echocardiography was performed in all patients after a mean follow-up of 58±13 months in (group A) and 42±16 months in (group U).
RESULTS: There were no early or late deaths. Both surgical techniques showed excellent immediate postoperative results regarding reduction of the mitral regurgitation (MR) grade (no to trivial) with highly accepted mean pressure gradients (MPG) through the mitral valve (2.3±0.6). Left ventricular function was maintained, and tricuspid regurgitation grade was reduced overall. During the follow-up period, Significant increase in the MPG was observed in (group A) with no significant change in the degree of mitral regurge. Analysis of this increase showed that the majority of them with significant increase are due to the rheumatic pathology(9/12). They became symptomatic and came out of the study after a follow up period of 41±13 months and their valves were replaced while those with non rheumatic pathology remained of reasonable gradient. Redo mitral valve replacement was done in only one patient in (group U) due to early endocarditis.
CONCLUSIONS: Despite the rationale is completely different in both techniques ( double orifice, double leaflet(A) versus Uni-leaflet, Uni-orifice(U) ),the long-term results are comparable in both. The U technique is mostly better in rheumatic patients but need more follow up on larger scales of this patient group.
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