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Eur J Cardiothorac Surg 2003;23:552-559
© 2003 Elsevier Science NL
a Cardiac Surgery Department, National Research Council, Ospedale G. Pasquinucci CNR-CREAS, v Massa, Italy
b Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy
Received 5 September 2002; received in revised form 16 December 2002; accepted 22 December 2002.
* Corresponding author. Tel.: +39-0585-4936-04; fax: +39-0585-4936-14
e-mail: bevilacqua{at}ifc.cnr.it
Objective: Biological and prosthestic rings are available for supporting mitral valve repair (MVR). Contrasting data are reported on the durability of pericardial ring annuloplasty. This retrospective study was undertaken to assess the durability of MVR for degenerative regurgitation with posterior annuloplasty performed with glutaraldehyde-treated autologous pericardium. Methods: From August 1995 through December 2000, 133 patients underwent mitral repair for degenerative regurgitation (86 men, age 62.9±11.5 years). Thirty patients (22.6%) underwent combined coronary artery bypass graft and fourteen (10.5%) underwent tricuspid annuloplasty. Associated aortic disease, previous cardiac surgery and endocarditis were considered exclusion criteria. Results: Seventy-seven patients (57.9%) received a Carpentier–Edwards ring and 56 received (42.1%) an autologous pericardium ring. Thirty-day mortality was 3.8%. Mean follow-up, 98.3% complete, was of 35.6±18.7 months. Five-year freedom from reoperation and recurrence of mitral regurgitation
3+/4+ was significantly higher in the prosthetic ring group (90.1% – CL90%: 81.9–98.3%) compared with the pericardial ring group (62.6% – CL90%: 43.1–82.1%; P=0.027). Prosthetic ring implantation (P=0.004; RR=0.11) and preoperative New York Heart Association (NYHA) class
II (P=0.011; RR=0.16) were independently related to a lower risk of reoperation and recurrence of mitral regurgitation3+/4+, by multivariate analysis. Five-year overall survival was 91.4% (CL90%: 87.9.7–95%). A higher preoperative left ventricular end-diastolic diameter (P=0.006; RR=1.17) and the severity of associated coronary artery disease (P=0.021; RR=2.00) were independent predictive factors for poor survival by multivariate analysis. Conclusions: Posterior pericardial annuloplasty can jeopardize reproducibility and durability of MVR for degenerative regurgitation.
Key Words: Mitral valve repair • Pericardial ring annuloplasty • Reoperation
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