Midterm Outcomes Using the Physio Ring in Mitral Valve Reconstruction: Experience in 492 Patients
Autor: | Kevin D. Accola, Meredith L. Scott, George Ebra, Paul A. Thompson, George J. Palmer, Mark E. Sand |
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Rok vydání: | 2005 |
Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine Thorax medicine.medical_specialty Adolescent medicine.medical_treatment Postoperative Complications Valve replacement Internal medicine Mitral valve Humans Medicine Endocarditis Hospital Mortality Myocardial infarction Stroke Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Intra-Aortic Balloon Pumping business.industry Atrial fibrillation Middle Aged medicine.disease Surgery medicine.anatomical_structure Cardiology Mitral Valve Female Morbidity Cardiology and Cardiovascular Medicine business Commissurotomy Follow-Up Studies |
Zdroj: | The Annals of Thoracic Surgery. 79:1276-1283 |
ISSN: | 0003-4975 |
Popis: | Background Mitral valve reconstruction using standardized Carpentier techniques is the treatment of choice for most patients with regurgitant lesions. Demonstrated predictability and stability make it an attractive alternative to valve replacement. The Physio Ring's inherent flexibility provides a viable alternative in the application of remodeling techniques and appears to be physiologically superior to traditional approaches. Methods Between April 1994 and October 2000, 492 consecutive patients underwent mitral valve reconstruction using standardized Carpentier techniques with the Carpentier-Edwards Physio Ring (Edwards Lifesciences LLC, Irvine, CA). There were 267 men (54.3%) and 225 women (45.7%). Mean age was 64.2 years (range, 18 to 86). Almost one-half (44.3%) were 70 years of age or over. The mitral valve etiology was congenital in 7 patients (1.4%), myxomatous in 351 patients (71.3%), ischemic in 88 (17.9%), rheumatic in 26 (5.3%), endocarditis in 9 (1.8%), calcific in 8 (1.6%), and other abnormalities in 3 (0.6%). Results Isolated mitral valve reconstruction was performed in 282 patients (57.3%), with coronary artery bypass grafting (CABG) in 182 (37.0%), with valve replacement in 11 (2.2%), and with CABG and valve replacement in 17 (3.5%). All patients (100.0%) had ring annuloplasty, 263 (53.5%) leaflet resection, 140 (28.5%) chordal resection, 55 (11.2%) chordal transposition, 48 (9.8%) chordal shortening, and 15 (3.0%) commissurotomy. Overall hospital mortality was 3.5% (17 of 492). Postoperative complications included respiratory insufficiency in 55 patients (11.2%), low cardiac output in 13 (2.6%), stroke in 14 (2.8%), reoperation for bleeding in 13 (2.6%), renal insufficiency in 21 (4.3%), and myocardial infarction in 5 (1.0%), and new onset of atrial fibrillation in 74 patients (15.0%). The cumulative follow-up for the series was 1,522.9 patient years and ranged from 1 to 101.0 months (mean, 38.5 months). There were 11 reconstruction failures (2.3%) requiring ring explant. Actuarial survival was 81.5% ± 2.1% at 4 years and 67.9% ± 4.6% at 7 years. Freedom from reoperation at 4 years was 81.5% ± 2.1% and 67.9% ± 4.6% at 7 years. Conclusions Mitral valve reconstruction with the Physio Ring can be accomplished with low hospital mortality and morbidity even in combined procedures. Moreover, the low incidence of reoperation and late cardiac events suggests that the Physio Ring, with its inherent flexibility, offers a definite advantage in the application of remodeling techniques in mitral valve reconstruction. |
Databáze: | OpenAIRE |
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