Korean J Thorac Cardiovasc Surg.  2005 Feb;38(2):132-138.

Analysis of Recurred Mitral Regurgitation after Mitral Repair according to Procedure or Valve Related Causes

• Shin HJ
• Yoo DG
• Lee YJ
• Park SI
• Choo SJ
• Song H
• Chung CH
• Song MG
• Lee JW

Abstract

BACKGROUND: Mitral valve repair (MVP) is the optimal procedure for mitral regurgitation (MR), however, failure and subsequent reoperations are the limitations. The current study assessed the procedure in relation to the primary valve related causes of recurrent MR. MATERIAL AND METHOD: MR was treated in 493 patients undergoing MVP from January of 1994 to January of 2002. The causes of MR were degenerative (n=252, 51.5%), rheumatic (n=156, 31.6%), and others (n=85, 16.9%). Surgery comprised 446 ring annuloplasties (90.5%), 227 new chordae formations (46%), 125 quadriangular resections (25.3%), 28 chordae transfers (5.7%), and 8 Alfieri's stitches (1.6%). The mean follow up was 29.04+/-22.81 months. RESULT: There were 5 early (1.01%), and 5 late deaths (1.01%). The reoperation rate was 1.42%. There were 45 (9.1%) recurrent MR (grade III or IV). Of these, 24 were procedure related including incomplete repair (n=14), discordant new chordae length (n=8) and others (n=2). In 21 patients, the cause was valve related including rheumatic disease progression (n=10), recurrent chordae elongation or prolapse (n=5) and others (n=6). Severe MR was higher after incomplete repair (p <0.001), and valve related failure strongly correlated with rheumatic progression (p <0.05).
CONCLUSION
Since completeness of operation is the prime risk factor that determine the repair durability, intra-operative assessment of the initial repair with trans-esophageal echocardiography is essential.

Keyword

Mitral valve, repair; Mitral valve regurgitation; Risk analysis

MeSH Terms

Echocardiography
Follow-Up Studies
Humans
Mitral Valve
Mitral Valve Insufficiency*
Prolapse
Reoperation
Rheumatic Diseases
Risk Factors