Willem Flameng, Bart Meuris, Paul Herijgers, Marie-Christine Herregods; Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
Objective: Previously we demonstrated (Circulation 2003;107:1609-1613) that the recurrence rate of severe regurgitation after successful mitral valve repair is 3.7% per year in degenerative mitral disease. However, we could not differentiate between Barlow Disease (BD) and Fibroelastic Deficiency (FD).Methods: We compared long term results of BD and FD in terms of echocardiographic recurrence of mitral valve regurgitation. In 348 patients (83 BD and 265 FD) we studied clinical outcome and mitral valve function using serial echocardiography postrepair.
Results: Clinical outcome after repair was excellent: survival at 10 years was 90.9 ± 3.2%, freedom of reoperation was 94.4 ± 1.6%. Freedom from severe (> 2/4) mitral regurgitation was 98.9 ± 1.2% at 1 month, but declined to 64.9 ± 5.6% at 10 years. Surgical techniques predictive for recurrent regurgitation in BD were the use of chordal shortening (p=0.002), the non-use of PTFE chordae (p=0.03) and the non-use of a stiff annuloplasty ring (p=0.0002). In FD these surgical factors were the non-use of sliding plasty (p=0.005) and the non-use of a stiff annuloplasty ring (p=0.0002). Linearized recurrence rates of regurgitation are given in the Table. When these techniques were avoided (optimal surgery, cfr. Table) the recurrence rates dropped to almost equal rates for BD and FD: 2.9% vs 2.2% per year (p=0.69). The only independent factor predicting this remaining 2-3% recurrence rate of regurgitation was the preoperative presence of abnormal and elongated chordae.
Conclusion: When optimal surgical repair techniques are used, BD and FD have a comparable but still significant recurrence rate of mitral regurgitation, possibly related to progression of chordal degeneration.
Linearized recurrence rates of MR > 2/4
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