Measured posterior annuloplasty for repair of non-ischemic mitral regurgitation. A single unit follow-up
Aarne J. Jyrala 1*,
Nicole M. Gatto 2,
Gregory L. Kay 1
1 Good Samaritan Hospital, Los Angeles, CA, USA
2 University of California Los Angeles, CA, USA
* To whom correspondence should be addressed. E-mail: aarnej{at}msn.com.
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Abstract |
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The aim of this report is to evaluate short- and long-term outcomes of annuloplasty method of our choice: measured posterior annuloplasty (MPA). MPA is a piece of a Duran ring cut to the length of free-edge of anterior mitral leaflet (AML) and anchored with multiple pledgeted U-sutures from trigone to trigone into the posterior annulus. Material and methods: From 1988 to 2000, 103 consecutive patients with non-ischemic mitral regurgitation were scheduled preoperatively to be repaired by MPA. Results: Preoperative mitral valve regurgitation (MR) grade was 3.8±0.5 and decreased to 0.1±0.3 (p<0.0001) after repair. One patient was converted to insertion of mechanical prosthesis after grade 3 MR persisted after septal myectomy and MPA. Three patients needed instant revision of the repair one due to SAM and 2 due to stenosis. No patient had a stenosis or unacceptable (>1) MR after the procedure. There was 1 operative death (1.0%) and 3 hospital/30 day deaths (2.9%). 16 patients (16.3%) expired during the follow-up to 91 months (mean 57.4±19.5, median 60 months) none due to failure of MPA. There were no reoperations due to failure of MPA. Three pts had a reoperation, one for dehiscence of reconstruction after P2 resection and two patients due to progression of anterior leaflet degeneration and calcification with 4+ MR. New York Heart Association (NYHA) functional classification decreased from 2.3±0.8 to 1.4±0.6 (p<0.0001) and only one patient had an increase from II to III. 88 patients (96.7%) were in NYHA class I-II. 10 pts had an increase of MR from 0 to trace or 1 and one from 0 to 2. 2 patients were diagnosed with mild stenosis without need of reoperation. Conclusions: MPA is a durable and stable alternative for repair of non-ischemic mitral regurgitation of different etiologies. The technique gives an objective measure of the length of the band and no patient is left with a significant MR or MS. First-time success rate is very high and instant repairs few and minor. Freedom of MPA related reoperations is 100%. Keywords: Mitral regurgitation; Annuloplasty; Measured posterior annuloplasty
