MITRAL-VALVE REMODELING - LONG-TERM RESULTS WITH POSTERIOR PERICARDIAL ANNULOPLASTY

Background. We studied the long-term results of a technique of mitral annuloplasty using autologous pericardium. Methods. Between June 1989 and December 1994, 113 mitral valvuloplasties were performed for myxom atous degenerative disease. Repair of isolated anterior leaflet prolap se was performed in 26 patients (23%), posterior leaflet prolapse in 3 8 (33.6%), and prolapse of both leaflets in 49 (43.4%). Posterior peri cardial annuloplasty was performed in all patients. In 20 patients, th e pericardial graft was marked with metal clips for postoperative cine fluoroscopic assessment of annulus motion. Results. The operative mort ality rate was 2.7% (3/113). One patient died of a myocardial infarcti on and 2 of low cardiac output syndrome. One patient required replacem ent of the mitral valve 2 days after operation because of dehiscence o f the annular plication. Follow-up (average length, 32.41 +/- 20.09 mo nths; range, 1 to 71 months) was 97% complete and revealed good clinic al and functional results: 95 patients (84.1%) were in New York Heart Association class I and had no regurgitation or only mild residual reg urgitation. Postoperative transmitral flow indices were almost normal (mitral valve area = 3.7 +/- 0.4 cm(2); peak flow velocity = 1.06 +/- 0.2 m/s). Only 3 patients had reoperation within 3 years (actuarial 5- year reoperation-free rate, 89.7%) and event-free survival at 5 years was 91%. In patients with metal clips marking autologous pericardium, planimetry of the area derived by fluoroscopic examination showed syst olic narrowing of annulus size (8.5% +/- 6.4%; p < 0.01) and a slight systolic fall in the anteroposterior diameter of the annulus contour ( 5.9% +/- 3.8%; p < 0.01). Conclusions. Posterior pericardial annulopla sty seems to be a safe, effective, and easily performed technique and a more physiologic correction that preserves mitral annulus motion.