Surgical outcomes of mitral valve replacement with concomitant mitral annular reconstruction

• Published in: Journal of cardiac surgery Vol. 33; no. 2; pp. 69 - 75
• Main Authors: Kim, Su Wan, Jeong, Dong Seop, Sung, Kiick, Kim, Wook Sung, Lee, Young Tak, Park, Pyo Won
• Format: Journal Article
• Language: English
• Published: United States 01.02.2018
• Subjects: annulus; bovine pericardium; endocarditis; mitral valve replacement; annulus; bovine pericardium; endocarditis; mitral valve replacement
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.13542

Background and aim of the study We evaluated the early and long‐term outcomes of mitral annular reconstruction (MAR) with pericardium during mitral valve replacement (MVR), and analyzed the risk factors associated with post‐operative mortality. Methods Between May 1997 and April 2013, 78 consecutive patients underwent MVR with MAR. The indications for MAR were treatment for annular infection in native valve endocarditis (n = 23, 29.5%) or prosthetic valve endocarditis (n = 26, 33.3%), reinforcement of damaged annulus resulting from a previous operation (n = 17, 21.8%), complete excision of extensive calcification (n = 9, 11.5%), and left ventricular or left atrial rupture (n = 3, 3.8%). Patients were classified into infective endocarditis (n = 49) and non‐endocarditis groups (n = 29). The mean follow‐up period was 59.4 ± 47.3 months. Results There were two operative deaths and 11 cases of late mortality in the endocarditis group and five cases in the non‐endocarditis group. Late prosthetic valve endocarditis occurred in four patients. The overall survival rate at 1 and 10 years was 94.8% and 65.1%, respectively. There was no statistical difference in the overall survival, freedom from reoperation, and freedom from endocarditis rates between the groups (P = 0.565, P = 0.635, and P = 0.449, respectively). Univariable and multivariable analyses revealed that pre‐operative left ventricular dysfunction (ejection fraction <40%) was an independent predictor of overall mortality. Conclusions The early and long‐term results of MAR with pericardium during MVR are acceptable in both endocarditis and non‐endocarditis patients.