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Clinical outcome and factors affecting surgical decision for repair versus replacement in patients with mitral regurgitation [Anatol J Cardiol]
Anatol J Cardiol. 2010; 10(4): 358-366 | DOI: 10.5152/akd.2010.096  

Clinical outcome and factors affecting surgical decision for repair versus replacement in patients with mitral regurgitation

Ahmet Rüçhan Akar1, Serkan Durdu2, Çağın Zaim3, Çağdaş Baran3, Timuçin Altın4, Cansın Tulunay Kaya4, Mustafa Kılıçkap4, Ömer Akyürek1, Ümit Özyurda5
1Ankara Üniversitesi Tıp Fakültesi, Kalp-Damar Cerrahisi Bölümü, Ankara, Türkiye
2Ankara Üniversitesi Biyoteknoloji Enstitüsü, Temel Biyoteknoloji Bölümü, Ankara, Türkiye Ankara Üniversitesi Tıp Fakültesi, Kalp-Damar Cerrahisi Bölümü, Ankara, Türkiye
3Ankara Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye
4Ankara Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
5Department of Cardiovascular Surgery Faculty of Medicine, Ankara University, Ankara

Objective: We aimed to identify characteristics differentiating patients undergoing mitral valve replacement versus valve repair for mitral regurgitation (MR) and to investigate retrospectively mid-term clinical and functional outcomes. Methods: From January, 2004 to January, 2009 146 patients underwent mitral valve surgery (62 male / 84 female; age: 55.9±13.6 [18-80] years) by one surgical team. Mitral valve replacement was performed in 101 patients (69.2 %) and valve repair was performed in 45 patients (30.8%). Mean follow-up time was 586±413 days. Life tables were constructed for the analysis of 5-year complication free survival and comparisons were performed between the groups using Log-rank test within 95%CI. Results: The choice of surgical technique depended on the etiology of MR. Degenerative (p<0.001) and ischemic (p=0.014) MR were more common in patients undergoing repair whereas patients with complex rheumatic mitral valve disease (p<0.001) with subvalvular involvement commonly underwent replacement. Overall 30-day mortality was 3.2% (replacement, 3.96%vs repair, 2.22%, p=0.59). Although there was no significant difference between the groups regarding baseline left ventricular ejection fraction (EF) (ischemic p=0.61; non-ischemic p=0.34), improvement was more pronounced in the repair group for both etiologies (ischemic MR, p=0.001; non- ischemic MR p=0.002). Survival at 5-years was 91.7±4.7% after repair and 83.5±9.2% after replacement, respectively (p=0.83). Freedom from grade 2 or more mitral regurgitation, reoperation, endocarditis, and thromboembolism were 95±5% vs 97±3% (p=0.71); 95±4% vs 98±2% (p=0.98); 94±4% vs 100% (p=0.16); and 85±8% vs 100% (p=0.095) in replacement and repair groups, respectively. Conclusion: This study demonstrates that mitral valve repair is associated with an acceptable operative mortality, satisfactory mid-term survival and better preservation of left ventricular function. Significant differences in favor of repair are expected in long-term follow-up particularly regarding freedom from thromboembolism and endocarditis.

Keywords: Mitral valve repair, mitral regurgitation, ventricular remodeling, survival analysis


Ahmet Rüçhan Akar, Serkan Durdu, Çağın Zaim, Çağdaş Baran, Timuçin Altın, Cansın Tulunay Kaya, Mustafa Kılıçkap, Ömer Akyürek, Ümit Özyurda. Clinical outcome and factors affecting surgical decision for repair versus replacement in patients with mitral regurgitation. Anatol J Cardiol. 2010; 10(4): 358-366


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