The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome

Objective: The 'double-orifice' (DO) technique has been recently proposed a s an additional option in mitral valve repair (MVR). However, little is kno wn regarding the long-term postoperative outcome and the predictors of DO r esults. Therefore, the aim of this study was to evaluate our clinical serie s and to identify prognostic factors of DO repair. Methods: From 1992, 75 p atients underwent DO procedure because of severe mitral regurgitation. The study population consisted of 48 male and 27 female patients with a mean ag e of 58 +/- 13 years (range 16-80 years). The aetiology of mitral incompete nce was Barlow disease in 30 cases, rheumatic disease in 18 cases, acute or healed endocarditis in 16 cases and other causes in 11 cases. Carpentier r igid ring was used in 38 patients, whereas autologous pericardium was used in 24 patients. Thirteen patients had no annuloplasty procedure. Statistica l analysis included univariate and multivariate Cox proportional models to evaluate the predictors of the DO failure. Results: There were four hospita l and three late deaths with a survival rate of 92% at 8 years. Mean follow -up was 42 +/- 24 months (range 1-93 months). Twelve patients underwent reo peration (five cases of early failure) and had valve replacement, leading t o 80% freedom from reoperation at 8 years. At follow-up, 13 patients had no mitral regurgitation, 36 patients had trivial or mild mitral incompetence, whereas eight patients had moderate or severe mitral insufficiency at tran sthoracic echocardiography. Preoperative low left ventricular ejection fact ion, pulmonary arterial hypertension and marked left atrial enlargement wer e predictors (P<0.05) of DO failure at univariate analysis. Pericardial ann uloplasty was also a risk factor (P<0.05) for unsuccessful DO repair at lon g term. Cox proportional multivariate analysis confirmed left atrial dilata tion, pulmonary hypertension and pericardial annuloplasty as independent pr edictors of unfavourable postoperative results. Conclusions: This study sug gests that preoperative factors, like pulmonary hypertension and severe lef t atrial dilatation, may predict late DO failure. Our findings also indicat e that pericardial annuloplasty may negatively influence mitral valve recon struction at long term when DO is employed in MVR. (C) 2001 Elsevier Scienc e B.V. All rights reserved.