Original articleAdult cardiacMitral Valve Repair for Degenerative Disease: A 20-Year Experience
Section snippets
Material and Methods
This study was performed with approval from the Duke Institutional Review Board and under a waiver of informed consent, but approval was not afforded for new late patient contact, unless the patient was already being followed under existing protocols. Therefore, only all-cause mortality data were available consistently. In the Duke Databank for Cardiovascular Disease, 2,580 patients with isolated mitral valve disease who underwent cardiac surgery from January 1, 1986, through December 31, 2006,
Results
The application of mitral valve repair versus replacement for degenerative disease increased steadily during the 20 years (Fig 1). Baseline characteristics for the total series of 989 patients subdivided into group 1 (repair) and group 2 (replacement) are shown in Table 1. Specifically worse risk factors for group 2 versus group 1 included greater age (68 years versus 62 years), more CABG surgery (32% versus 24%), and more nonelective surgery (34% versus 25%), whereas group 1 had worse
Comment
Many patients in this series may have received valve replacement because of surgeon choice, but it is also likely that most of the replacement patients had anatomy that was difficult to repair, such as Barlow's valves or bileaflet prolapse. Because these details of valve anatomy were not captured in the databank, one might argue that group comparisons in this paper are not strictly quantitative. However, significant changes in techniques of repair have occurred recently [29, 30], and now most
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2023, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Mitral valve repair is the preferred surgical strategy for mitral valve regurgitation in the current guidelines.1,2 In specialized centers, repair rate of degenerative disease ranges from 71 – 100% with excellent short- and long-term results.3–5 These results are explained by the absence of prosthesis related complications (e.g. thromboembolic events, bleeding from anticoagulation and endocarditis) and positive left ventricular remodeling due to preservation of sub valvular apparatus.6,7