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Surgical management of mitral regurgitation after repair of endocardial cushion defects: early and midterm results.

Abstract：

BACKGROUND:Mitral regurgitation (MR) represents the principal indication for reoperation in patients after repair of atrioventricular septal defects (AVSD). Reports of mitral valvuloplasty (MVP) in such patients are few; the alternative, mitral valve replacement (MVR), necessitates commitment to future valve replacement and long-term anticoagulation. We sought to determine the outcome of those patients who underwent either MVP or MVR between January 1, 1988, and December 31, 1998, for significant MR after repair of AVSD. Furthermore, we sought to identify (a) morphological predictors necessitating MVR, and (b) predictors of future reoperation within the MVP group. METHODS AND RESULTS:Retrospective review of clinical, operative, and echocardiographic data were performed. There were 46 patients identified (37 MVP and 9 MVR). The median age at initial AVSD repair was 0.6 years, and the age at subsequent mitral valve operation was 2.8 years. The early postoperative mortality rate was 2.2%, and survival at 1 and 10 years was 89.9% and 86.6%, respectively. A high rate of complete heart block was noted within the MVR group (37.5%). Freedom from later mitral valve reoperation for both groups was similar. No significant morphological predictors necessitating MVR were found. Predictors of reoperation within the MVP group included the presence of moderate or worse MR in the early postoperative period. In both groups New York Heart Association class, degree of MR, growth, and ventricular volumes improved. CONCLUSIONS:Mitral valve surgery significantly improves clinical status, with a sustained improvement in ventricular chamber size. MR can be successfully managed in patients after repair of AVSD independent of morphological type. Overall survival is acceptable, and further reoperation within the MVP group is influenced by early outcome of repair.

journal_name

Circulation

journal_title

Circulation

authors

Moran AM,Daebritz S,Keane JF,Mayer JE

doi

10.1161/01.cir.102.suppl_3.iii-160

subject

Has Abstract

pub_date

2000-11-07 00:00:00

pages

III160-5

issue

19 Suppl 3

eissn

0009-7322

issn

1524-4539

journal_volume

102

pub_type

杂志文章

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Surgical management of mitral regurgitation after repair of endocardial cushion defects: early and midterm results.