Long-term Results Of Partial Versus Complete Annuloplasty Ring Mitral Valve Repair
Ayse Cetinkaya1, Karin Bramlage2, Stefan Hein1, Markus Schönburg1, Peter Bramlage2, Manfred Richter1.
1Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany, 2Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
Objectives: Mitral valve repair consist of two essential parts, restoration of leaflet coaptation and the implantation of standardized annuloplasty rings. Aim of this analysis was to compare the outcome after mitral valve (MV) surgery using open annuloplasty rings (OA) versus closed annuloplasty rings (CA). Methods: A registry of 1008 pts receiving MVR between 2005 and 2015 was established of which 470 received an open (Cosgrove) and 538 a closed (CE Physio) annuloplasty ring. Outcomes at 30 days and over the long term were compared and results adjusted for baseline variables. Results: Pts receiving OA were older (median 66.0 vs. 63.0 years; p=0.018), had undergone more prior aortic valve replacements (1.9% vs. 0.6%; p=0.047), had more pulmonary hypertension (p=0.039) and a higher median log EuroSCORE (3.4% vs. 2.8%; p=0.022). They were otherwise comparable to pts receiving CA. In addition to annuloplasty, repair techniques less often used in OA were AML reconstruction (12.3 vs. 21.6%; p<0.001), AML artificial chordae (9.1 vs. 13.8%; p=0.023) and cleft plicature (13.8 vs. 29.2%, p<0.001) while quadrangular PML resection was more common (19.8 vs. 10.6%; p<0.001) than in CA. Procedural peri-operative mortality was 0.5%, atrial fibrillation 15.9%, third degree AV block 5.7%, pneumonia 3.3%, pericardial tamponade 2.8%, wound infection 1.2% and pneumothorax 0.9% with no significant difference between groups. Only pleural effusion was less common in OA (1.5%) than in CA (2.8%; adj OR 0.25; 95%CI 0.07 to 0.88). Similarly 30 day outcomes were comparable with a mortality rate of 2.0% and a 5.7% re-thoracotomy rate. Estimated 10 year survival rates were 79.1% in the OA and 73.8% in the CA group (p=0.164). Conclusion: In patients with open and closed annuloplasty rings procedural as well as short- and long-term outcomes are excellent. We saw no impact of differing additional repair techniques on the long-term durability of the result.
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