Long Term Clinical Results of Mitral Valvuloplasty Using Flexible and Rigid Ring : Prospective and Randomized study
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Objective: Carpentier rigid ring and Duran flexible ring have been used for mitral valve repair. Carpentier ring reduces mitral insufficiency very effectively, but it causes minor systolic dysfunction and Duran ring preserves the left heart geometry changing mitral valve area at systolic phase. But the comparison of long term results of mitral valvuloplasty using Carpentier ring and Duran ring have been unknown.
Methods: From January 1995 to August 2005, 411 patients underwent mitral valvuloplasty using Carpentier ring (n=222) and Duran ring (n=189). We chose the ring with randomization for mitral valve repair. Mean age was 50.2 year and 50.8 years each. There were no significant differences in age, sex, body surface area, etiology of mitral regurgitation between two groups.
Results: There were 7 (1.7%) operative mortalities. The patients were followed up 3 to 126 months (mean 43.6 months) and total follow-up time was 1494.5 patient-years. The LVEDD (Left ventricular end diastolic diameter), LVESD (Left ventricular end systolic diameter) and left atrial size were significantly decreased in both groups. But, there was no difference in the long term echocardiographic results between two groups. Overall actuarial survival rates at 10 years were 85.2±4.6% in Carpentier ring group and 76.3±8.4% in Duran ring group without significant difference. Significant mitral regurgitation (grade ≥3) recurred in 25 patients (Carpentier ring group : Duran ring group=8:17). The 10 year freedom rate from recurrence of significant mitral regurgitation was 88.5±4.8% and 68.1±9.6% each (p=0.155). Dependent prognostic factors for recurrence of mitral regurgitation in logistic regression analysis were preoperative left atrial size and residual mitral regurgitation at 7th postoperative days.
Conclusions: The mitral valvuloplasty favors the excellent surgical and long term results in our prospective randomized study regardless of type of annuloplasty ring. Timing of operation before significant enlargement of left atrium and precise mitral valve repair may prevent late recurrence of mitral regurgitation.
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