Mitral Valve Repair is Feasible Following Extensive XXXX and Reconstruction of the Atrioventricular Groove.

@entity1 @entity339 @entity8704 @entity730 @entity397 @entity2142 @entity204 @entity291 @entity884
BACKGROUND AND AIM OF THE STUDY: @entity730 ( @entity730 ) represents a significant challenge in mitral valve (MV) surgery. Techniques to decalcify the mitral annulus significantly increase operative complexity and risk. MV repair can be particularly difficult in this setting. Mid-term outcomes following MV surgery with extensive @entity8704 were examined, with attention focused on the feasibility and outcomes of MV repair in this setting. METHODS: Among 1,485 @entity1 undergoing MV surgery between 1999 and 2008 at the authors' institutions, 24 (1.6%) underwent complete posterior MV @entity8704 associated with either MV repair (n = 19) or replacement (n = 5). Extensive @entity8704 was performed from commissure to commissure in all @entity1 . The annulus was reconstructed with pledgeted compression sutures in 17 @entity1 , and with a @entity291 pericardial patch in seven. RESULTS: In-hospital mortality was 12.5%. One @entity1 died in the operating room from @entity397 , and two @entity1 died from low cardiac output postoperatively. During a mean follow up of 4.4    2.7 years, eight @entity1 died; five of these deaths were cardiovascular in nature. After five years the actuarial survival was 56    11%, and freedom from @entity204 63    11%. Four @entity1 underwent' reoperation because of failure of MV repair (n = 2), @entity884 (n = 1) or @entity2142 (n = 1). All survivors were in NYHA class  <= 2, with none to trivial @entity339 in all MV repairs. The five-year freedom from MV reoperation was 82    8%. CONCLUSION: After aggressive @entity8704 of the posterior MV annulus, both MV repair and replacement were feasible, with acceptable procedure-related mortality. It was clear however, that @entity8704 increased both complexity and risk. In well-selected @entity1 , an aggressive approach to MV repair might facilitate a high rate of repair with acceptable midterm outcome in this @entity1 population.
