PMID- 15854923
OWN - NLM
STAT- MEDLINE
DCOM- 20060814
LR  - 20050427
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 79
IP  - 5
DP  - 2005 May
TI  - Anterior leaflet repair with patch augmentation for mitral regurgitation.
PG  - 1500-4; discussion 1500-4
AB  - BACKGROUND: Anterior leaflet repair continues to pose significant operative 
      challenges, particularly in patients with retracted or "short" anterior leaflets, 
      due to rheumatic or radiation induced mitral valve disease. This often results in 
      abandonment of repair in favor of mitral valve replacement, requiring 
      anticoagulation and altering left ventricular (LV) function and geometry. This 
      study examines our experience of anterior leaflet repair with patch augmentation. 
      METHODS: Forty-two patients underwent mitral valve repair for a shortened 
      anterior leaflet from 1994 to 2003. Twenty-two patients with a mean age of 53 +/- 
      6 years had radiation valvulitis (XR) whereas 20 patients, age 28 +/- 7 years had 
      rheumatic heart disease (RHD). Those patients with XR had a mean New York Heart 
      Association (NYHA) class of 3.2 +/- 0.4 and an angina score of 2.1 +/- 0.6 
      compared with a NYHA class 3.8 +/- 0.2 and no angina in RHD patients. All 
      patients presented with severe MR. Anterior leaflet augmentation with a 
      gluteraldehyde-treated, autologous pericardial patch and complete annuloplasty 
      ring was used in all patients. Additionally, extensive subvalvar debridement was 
      performed in RHD patients. Twelve XR patients underwent concomitant CABG with a 
      mean of 2.4 +/- 0.8 grafts/patient. Additional surgical procedures included 
      tricuspid valve repair, anterior septal defect, and aortic valve replacement. 
      Mean follow-up was 39 +/- 10 months for XR patients and 12 +/- 25 months for RHD 
      patients. RESULTS: There were two late deaths in XR patients from underlying 
      malignancies and no deaths in RHD patients. Two RHD patients required reoperation 
      for recurrent mitral regurgitation at 3 and 20 months. All patients demonstrated 
      clinical improvements (NYHA I-II) following repair. No mitral stenosis was 
      induced. CONCLUSIONS: Despite anterior leaflet shortening from XR or rheumatic 
      alterations, opportunity still exists for gratifying mitral valve repair. By 
      utilizing anterior leaflet patch augmentation, concomitantly with ring 
      annuloplasty, anticoagulation is avoided, LV geometry is preserved, and follow-up 
      reveals excellent functional improvement.
FAU - Romano, Matthew A
AU  - Romano MA
AD  - Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Patel, Himanshu J
AU  - Patel HJ
FAU - Pagani, Francis D
AU  - Pagani FD
FAU - Prager, Righard L
AU  - Prager RL
FAU - Deeb, G Michael
AU  - Deeb GM
FAU - Bolling, Steven F
AU  - Bolling SF
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Cardiac Surgical Procedures/*methods
MH  - Follow-Up Studies
MH  - Humans
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*surgery
MH  - Neoplasms/complications/radiotherapy
MH  - Reoperation
MH  - Retrospective Studies
MH  - Rheumatic Heart Disease/complications
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tricuspid Valve/surgery
EDAT- 2005/04/28 09:00
MHDA- 2006/08/15 09:00
CRDT- 2005/04/28 09:00
PHST- 2004/08/23 00:00 [accepted]
PHST- 2005/04/28 09:00 [pubmed]
PHST- 2006/08/15 09:00 [medline]
PHST- 2005/04/28 09:00 [entrez]
AID - S0003-4975(04)02305-7 [pii]
AID - 10.1016/j.athoracsur.2004.08.086 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2005 May;79(5):1500-4; discussion 1500-4. doi: 
      10.1016/j.athoracsur.2004.08.086.