Edge-to-edge mitral valve repair: the Columbia Presbyterian experience

• Published in: The Annals of thoracic surgery Vol. 78; no. 1; pp. 73 - 76
• Main Authors: Kherani, Aftab R, Cheema, Faisal H, Casher, Jennifer, Fal, Jennifer M, Mutrie, Christopher J, Chen, Jonathan M, Morgan, Jeffrey A, Vigilance, Deon W, Garrido, Mauricio J, Smith, Craig R, Oz, Mehmet C
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2004; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - statistics & numerical data; Cardiology. Vascular system; Cardiovascular Agents - therapeutic use; Coronary Artery Bypass - statistics & numerical data; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Atria - surgery; Heart Septal Defects, Atrial - surgery; Heart Septal Defects, Ventricular - surgery; Humans; Life Tables; Male; Medical sciences; Middle Aged; Mitral Valve - surgery; Mitral Valve Insufficiency - drug therapy; Mitral Valve Insufficiency - epidemiology; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; New York City; Pneumology; Postoperative Complications - surgery; Reoperation - statistics & numerical data; Retrospective Studies; Survival Analysis; Treatment Outcome; New York City; 35; Mitral valve; Cardiac valvular disease; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Mitral valve disease; Edge
• DOI: 10.1016/j.athoracsur.2003.08.085
• EISSN: 1552-6259
• ISSN: 0003-4975

The edge-to-edge mitral valve repair, first described by Alfieri in 1995 treats mitral regurgitation when standard reparative techniques are difficult, unlikely to succeed, or have failed. This study examines one institution's medium-term experience with this procedure.
This study involved patients undergoing edge-to-edge mitral valve repair at a single institution from 1997 to 2003. Preoperative and postoperative echocardiograms were compared. Postoperative morbidity was examined including need for reoperation and long-term medical management. Thirty-day survival and long-term actuarial survival were also determined.
Seventy-one patients comprised this study. Mitral regurgitation on echocardiogram went from 3.43 ± 0.86 to 0.39 ± 0.61 (p < 0.001) following repair. Thirty-day mortality was 3 of 71 (4.2%) patients. Actuarial survivals at 24 and 60 months were 84.5% and 58.3%, respectively; adjusted excluding noncardiac death they were 89.5% and 82.3%, respectively. Forty (56.3%) patients had concomitant ring placement and experienced similar survival to those repaired with the bow-tie stitch alone. Home telephone follow-up was conducted, and current medical therapy was determined on 51 patients; 59% were on a β-blocker, 31% were on an angiotensin-converting enzyme (ACE) inhibitor, 27% were on a diuretic, and 22% were on digoxin. All were New York Heart Association (NYHA) class I or II. Three patients (4.2%) underwent mitral valve reoperation after a mean of 299 ± 429 days. In no case did the bow-tie suture rupture.
Edge-to-edge mitral valve repair is a valuable tool in the armamentarium available to treat complex cases of mitral insufficiency or as an adjunct to standard repair techniques that fail to achieve an acceptable result.