Integrated application of multiple valvular plasty techniques for repairing complex mitral insufficiency: clinical experience of a single center

AIM: To retrospectively summarize mid-term clinical results of repairing complex mitral valve insufficiency with multiple valvular plasty techniques. METHODS: From January 2003 to March 2014,23 patients with mitral valve insufficiency age 14-71( 45 ± 23) yearswere included in the study. The causes of mitral insufficiency consisted of mitral valve mucous degeneration( n = 14),mitral chordae tendinae rupture( n = 5),secondary atrial septal defect( n = 1),infectious lesions( n = 1) and coronary heart disease with mitral papillary muscle dysfunction( n = 2). Preoperative echocardiography showed moderate mitral valve insufficiency in six cases and severe insufficiency in 17 cases. Multiple techniques including edge to edge mitral repair,rectangular resection of posterior leaflet flap,tendon transfer,chordate shortening,artificial chordate implantation,and prosthetic annuloplasty ring implantation were used to restore the functional anatomy of mitral valves. Hydrostatic test and transesophageal echocardiography were used to evaluate the effects of mitral valve repair during the operation. Follow-up was conducted with yearly transthoracic echocardiography annually for all postoperative patients. Mid-to long-term mortality and freedom from moderate to severe mitral regurgitation were estimated with Kaplan-Meier method.RESULTS: There were no intra-hospital deaths. The average follow-up time was( 71 ± 37) months and two patients( 8. 7%) were absent from follow-up. During the follow-up,one patient died of heart failure and the overall estimated survival rate in the 11 years for this cohort of patients was 95%. According to the last results of echocardiography,moderate mitral valve regurgitation recurred,respectively 9,72 and96 months after operation in 3 /22 surviving patients and the recurrence rate of the estimated freedom from moderate to severe mitral valve insufficiency was 76. 4%. No patient underwent re-operation due to recurrence of mitral valve insufficiency or other reasons. CONCLUSION: Integrated application of multiple techniques of mitral valve plasty based on careful evaluation of pathological changes of the mitral valve produces good mid-to long-term results in patients with complex mitral valve insufficiency.