PRIMARY MITRAL REGURGITATION AND RESULTS OF SURGICAL MANAGEMENT IN A PROSPECTIVE STUDY
Mitral regurgitation (MR) remains the second dominant defect in the structure of valvular cardiac diseases .
It affects more than 2 million people in the USA. Basic causes are classified as degenerative (with valve prolapse) and ischemic (due to ischemic heart disease) in advanced countries or rheumatic ones (in developing countries) [2, 3].
Alone radical method of MR treatment is surgical correction through mitral valve repair (MVRe) or replacement (MVR) yielding definitely higher survival percentage and improvement of heart failure (HF) class comparing to pharmacotherapy .
Evolution of approaches to the management of non-ischemic MR passed through some stages, starting from predominantly MVR to organ-preserving approaches like plastic repair .
In the prospective single-center study the results of treatment of 72 patients with primary MR (PMR) who were subjected to mitral valve replacement (MVR) or plastic mitral valve repair (MVRe) performed in the Department of cardiac surgery affiliated with Lviv regional clinical hospital (Ukraine) since October, 2013 till February, 2016 were analyzed.
The conclusions of performed study are the following:
1) Key direct cause of MR is the chordal rupture of MV cusps, etiological factor in the majority of advanced countries is degenerative changes in contrast to rheumatic changes in the developing countries.
2) Principal method of MR surgical correction in out center is MVR, though the preferable global trend is MVRe.
3) Complications and lethality percentages in this study were higher among the patients from MVR group. Improvement of HF class according to NYHA was more evident in the MVRe group.This corresponds to results of other studies and guidelines that recommend MVRe as optional method for MR correction
Iung, B. (2003). A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. European Heart Journal, 24 (13), 1231–1243. doi: 10.1016/s0195-668x(03)00201-x
Enriquez-Sarano, M., Akins, C. W., Vahanian, A. (2009). Mitral regurgitation. The Lancet, 373 (9672), 1382–1394. doi: 10.1016/s0140-6736(09)60692-9
Gillinov, A. M., Cosgrove, D. M., Blackstone, E. H., Diaz, R., Arnold, J. H., Lytle, B. W. et. al. (1998). Durability of mitral valve repair for degenerative disease. The Journal of Thoracic and Cardiovascular Surgery, 116 (5), 734–743. doi: 10.1016/s0022-5223(98)00450-4
Ling, L. H., Enriquez-Sarano, M., Seward, J. B., Orszulak, T. A., Schaff, H. V., Bailey, K. R. et. al. (1997). Early Surgery in Patients With Mitral Regurgitation Due to Flail Leaflets : A Long-term Outcome Study. Circulation, 96 (6), 1819–1825. doi: 10.1161/01.cir.96.6.1819
Adams, D. H., Rosenhek, R., Falk, V. (2010). Degenerative mitral valve regurgitation: best practice revolution. European Heart Journal, 31 (16), 1958–1966. doi: 10.1093/eurheartj/ehq222
Otto, C. M. (2001). Evaluation and Management of Chronic Mitral Regurgitation. New England Journal of Medicine, 345 (10), 740–746. doi: 10.1056/nejmcp003331
Enriquez-Sarano, M., Basmadjian, A.-J., Rossi, A., Bailey, K. R., Seward, J. B., Tajik, A. J. (1999). Progression of mitral regurgitation. Journal of the American College of Cardiology, 34 (4), 1137–1144. doi: 10.1016/s0735-1097(99)00313-7
Gammie, J. S., Sheng, S., Griffith, B. P., Peterson, E. D., Rankin, J. S., O’Brien, S. M., Brown, J. M. (2009). Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Database. The Annals of Thoracic Surgery, 87 (5), 1431–1439. doi: 10.1016/j.athoracsur.2009.01.064
Mirabel, M., Iung, B., Baron, G., Messika-Zeitoun, D., Detaint, D., Vanoverschelde, J.-L. et. al. (2007). What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? European Heart Journal, 28 (11), 1358–1365. doi: 10.1093/eurheartj/ehm001
Lazopoulos, G., Mihas, C., Manns-Kantartzis, M., Kantartzis, M. (2013). Radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery. Herz, 39 (2), 206–211. doi: 10.1007/s00059-013-3787-1
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