
Valvuloplasty Without Prosthetic Ring or Band in Patients with Degenerative Mitral Regurgitation: Long-Term Results and Predictive Factors for Outcomes
Author(s) -
Renato A. K. Kalil,
Karlyse Claudino Belli,
Mariana Oliveira Tripoli de Mattos,
Rita de Cássia E. Sffair,
Márcia Rosa de Oliveira,
Vitória Recuero Fagundes,
Rogério Abrahão,
Álvaro Albrecht,
João Ricardo Michielin Sant'Anna,
Paulo R. Prates,
Ivo A. Nesralla,
Fernando Pivatto Júnior
Publication year - 2021
Publication title -
brazilian journal of cardiovascular surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.324
H-Index - 26
eISSN - 1678-9741
pISSN - 0102-7638
DOI - 10.21470/1678-9741-2020-0520
Subject(s) - medicine , mitral regurgitation , hazard ratio , confidence interval , proportional hazards model , euroscore , cardiology , univariate analysis , retrospective cohort study , surgery , mitral valve , mitral valve repair , cohort , cardiac surgery , multivariate analysis
Mitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings. Unsupported valvuloplasty is performed in only a few centers. This study aimed to report long-term outcomes of patients undergoing unsupported valvuloplasty for degenerative mitral regurgitation (MR) and to identify predictive factors for outcomes. Methods This is a retrospective cohort including patients undergoing mitral valve repair for degenerative MR from 2000 to 2018. The main techniques were Wooler annuloplasty and quadrangular resection. Kaplan-Meier curves and Cox regression models were used for statistical analysis. Results One hundred fifty-eight patients were included (median age: 64.0 years). In-hospital mortality was 2.5%. Maximum follow-up was 19.6 years, with a median of 4.7 years (992 patient-years). Overall survival at 5, 10, and 15 years was 91.0% (95% confidence interval [CI]: 85.7-96.3), 87.6% (95% CI: 80.7-94.5), and 78.1% (95% CI: 65.9-90.3), respectively. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was an independent predictor of late death (hazard ratio [HR] 1.42; P =0.016). Freedom from mitral reoperation at 5, 10, and 15 years was 88.1% (95% CI: 82.0-94.2), 82.4% (95% CI: 74.6-90.2), and 75.7% (95% CI: 64.1-87.3), respectively. Left atrial diameter > 56 mm was associated with late reintervention in univariate analysis (HR 1.06; P =0.049). Conclusion Degenerative MR can be successfully treated with repair techniques without annular support, thus avoiding the technical and logistical drawbacks of ring/band implantation while maintaining good long-term results. EuroSCORE II was a risk factor for late death, and larger left atrium was associated with late reoperation.