Valvuloplasty Without Prosthetic Ring or Band in Patients with Degenerative Mitral Regurgitation: Long-Term Results and Predictive Factors for Outcomes
Kalil, Renato A. K.; Belli, Karlyse C.; Mattos, Mariana O. T. de; Sffair, Rita de Cássia E.; Santos, Sarah Ceolin Stein; Fagundes, Vitória Recuero; Abrahão, Rogério de Souza; Albrecht, Álvaro Schmidt; SantAnna, João Ricardo Michielin; Prates, Paulo Roberto; Nesralla, Ivo Abrahão; Pivatto Júnior, Fernando.
Rev. bras. cir. cardiovasc
; 36(4): 476-483, July-Aug. 2021. tab, graf
Artículo
en Inglés
| LILACS | ID: biblio-1347159
Abstract
Introduction:
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.
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