PMID- 30377076
OWN - NLM
STAT- MEDLINE
DCOM- 20200415
LR  - 20200415
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 28
IP  - 12
DP  - 2019 Dec
TI  - Long-Term Results Following Repair for Degenerative Mitral Regurgitation - 
      Analysis of Factors Influencing Durability.
PG  - 1852-1865
LID - S1443-9506(18)31952-8 [pii]
LID - 10.1016/j.hlc.2018.10.011 [doi]
AB  - BACKGROUND: The majority of patients with degenerative mitral regurgitation (DMR) 
      are amenable to reconstructive procedures. There is debate regarding factors that 
      influence long-term durability with respect to repair technique, valve 
      remodelling and progressive myxomatous change. METHODS: A total of 685 patients 
      with DMR underwent mitral valve repair by a single surgeon between 1991 and 2011 
      with follow-up completed at 31 December 2016. Repair rate for patients undergoing 
      surgery for DMR was over 90%. Mean age was 64 years (18-89) with 66.2% male, 47% 
      NYHA class III-IV, and 20% had permanent atrial fibrillation (PAF). Major 
      associated procedures were performed in 28% of patients (189); including coronary 
      artery bypass graft (CABG) (127), aortic valve replacement (15), aortic root 
      surgery (3) and tricuspid valve annuloplasty (61). RESULTS: Operative mortality 
      (</=30 days) occurred in four patients (0.58%). At 20 years, survival was 58%, 
      freedom from reoperation was 90% and freedom from reoperation and non-operated 
      recurrent MR >2+ (relapse) was 78%. Factors influencing survival were advancing 
      age, left ventricular (LV) dysfunction (ejection fraction <60% or end systolic 
      dimension >40mm), New York Heart Association (NYHA) III-IV and PAF. Predictors of 
      relapse were the degree of residual intraoperative mitral regurgitation 
      (p<0.001), anterior leaflet prolapse (p<0.001) and the addition of a sliding 
      annuloplasty in isolated posterior leaflet repair (p=0.023). The majority of 
      reoperations were for technical issues related to the original repair. A 
      competent valve at 6 months to 3 years postoperatively predicted an excellent 
      long-term result. CONCLUSION: The great majority of degenerative mitral valves 
      are repairable regardless of age with excellent long-term results achievable 
      following surgery. Survival is reduced by significant symptoms, LV dysfunction 
      and preoperative PAF. Repair is best performed before these features develop. 
      Durability is largely dependent on the technical performance of the repair and 
      degree of residual MR on the post-pump transoesophageal echocardiogram. We 
      recommend surgery should be performed by surgeons specialising and skilled in 
      mitral valve repair.
CI  - Copyright (c) 2018 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      Published by Elsevier B.V. All rights reserved.
FAU - Gardner, Michael Anthony
AU  - Gardner MA
AD  - St Andrew's War Memorial Hospital, Brisbane, Qld, Australia. Electronic address: 
      mahg@bigpond.net.au.
FAU - Hossack, Kenneth F
AU  - Hossack KF
AD  - St Andrew's War Memorial Hospital, Brisbane, Qld, Australia.
FAU - Smith, Ian R
AU  - Smith IR
AD  - St Andrew's War Memorial Hospital, Brisbane, Qld, Australia.
LA  - eng
PT  - Journal Article
DEP - 20181017
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Atrial Fibrillation/diagnostic imaging/etiology/mortality/physiopathology
MH  - Disease-Free Survival
MH  - *Echocardiography, Transesophageal
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/diagnostic imaging/physiopathology/surgery
MH  - *Mitral Valve Insufficiency/diagnostic imaging/mortality/physiopathology/surgery
MH  - *Postoperative Complications/diagnostic imaging/mortality/physiopathology
MH  - Risk Factors
MH  - Survival Rate
MH  - Tricuspid Valve/diagnostic imaging/physiopathology/surgery
OTO - NOTNLM
OT  - Annuloplasty
OT  - Degenerative mitral regurgitation
OT  - Durability
OT  - Mitral valve repair
OT  - Reoperation
OT  - Survival
EDAT- 2018/11/01 06:00
MHDA- 2020/04/16 06:00
CRDT- 2018/11/01 06:00
PHST- 2018/07/12 00:00 [received]
PHST- 2018/10/04 00:00 [accepted]
PHST- 2018/11/01 06:00 [pubmed]
PHST- 2020/04/16 06:00 [medline]
PHST- 2018/11/01 06:00 [entrez]
AID - S1443-9506(18)31952-8 [pii]
AID - 10.1016/j.hlc.2018.10.011 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2019 Dec;28(12):1852-1865. doi: 10.1016/j.hlc.2018.10.011. Epub 
      2018 Oct 17.