Causes of Reoperation After Mitral Carpentier Ring Annuloplasty: Report of Five Cases

Year 2003, Volume: 4 Issue: 1, 17 - 20, 01.04.2003

Uğur Gürcün M. İsmail Badak Mehmet Boğa Erdem A. Özkısaclk Berent Dişcigil Ahmet Hamulu Suat Buket İsa Durmaz

Abstract

Purpose: Mitral valve reconstruction is the treatment of choice in mitral regurgitation. In this study, the causes of reoperation following mitral reconstruction with Carpentier ring annuloplasty are discussed. Material and Method: Five patients who underwent reoperation late after mitral ring annuloplasty with Carpentier ring were reviewed. Patients were all female, mean age was 44.6+11.2 (range 32 58 years) and the mean interval between the two procedures was 32+28.4 (range 7-78) months. All patients had history of rheumatic fever. Prior to mitral reconstruction, four patients had moderate to severe mitral regurgitation, one patient had severe mitral stenosis. Associated procedures were aortic valve replacement in one patient, tricuspid annuloplasty in four patients during mitral reconstruction. Indications for reoperation were severe mitral regurgitation in three patients and third degree regurgitation with mitral stenosis in two. Results: The reasons for reoperation for the failed mitral reconstruction were procedure related in one patient and progression of the rheumatic disease in four patients. All patients underwent mitral valve replacement with mechanical bileaflet prosthesis. Associated procedures were aortic valve re-replacement in one patient, tricuspid annuloplasty in all five patients, ring was used in two. One patient died in hospital. In early follow-up, all four surviving patients were found to be in NYHA functional class I-II and have normally functioning mitral prosthesis. One patient had minimal, three patients had moderate tricuspid regurgitation. Conclusion: This study considered that the reason for reoperation for failed mitral reconstruction is mainly related with the progression of mitral valve pathology or inadequate surgical technique and early results of reoperation of these patients are good.

Keywords

Mitral valve, ring annuloplasty, reoperation

References

• 1. Deloche A, Jebara VA, Relland JY, et al. Valve repair with Carpentier techniques: the second decade. J Thorac Cardiovasc Surg 1990; 99:990-1002.
• 2. Galloway AC, Colvin SB, Baumann FG, Harty S, Spencer FC. Current concepts of mitral valve reconsruction for mitral insufficiency. Circulation 1988; 78:1087-98.
• 3. GallowayAC, Colvin SB, Baumann G, et al. Long-term results of mitral valve reconsruction with Carpentier techniques in 148 patients with mitral insufficiency. Circulation 1988; 78(Suppl): 97-105.
• 4. Duran CMG. Perspectives in reparative surgery for acquired valvular disease. Adv Card Surg 1993; 4: 1- 23.
• 5. Gillinov AM, Cosgrove DM, Lytle BW, et al. Reoperation for failure of mitral valve repair. J Thoracic Cardiovasc Surg 1997; 113: 467-73.
• 6. Cosgrove DM, Chavez AM, Lytle BW, et al. Results of mitral valve reconstruction. Circulation 1986; 74 (Suppl): 182-7.
• 7. Perier P, Deloche A, Chauvaud S, et al. Comparative evaluation of mitral valve repair and replacement with Starr, Björk and porcine valve protheses. Circulation 1984; 70(Suppl):I187-92.
• 8. Fernandez J, Joyce DH, Hirschfeld K, et al. Factors affecting mitral valve reoperation in 317 survivors after mitral valve reconsruction. Circulation 1988; 78: I97- 105.
• 9. Yun KL, Miller DC Mitral valve repair versus replacement Cardiol Clin. 1991; 9:315-27.
• 10. Pansini S, Summa M, Gagliardotto P, et al. Conservative surgical treatment of rheumatic mitral stenosis. Cardiologia. 1995; 40:261-6.
• 11. Duran CMG, Gometza B, Saad E, De vol EB: Valve repair in rheumatic mitral disease: unsolved problem. J Card Surg 1994; 9(Suppl):282-5.
• 12. Duran CMG, Revuelta JM, Gaite L, Alonso C, Fleitas MG. Stability of mitral reconstructive surgery at 10-12
• years for predominantly rheumatic valvular disease. Circulation 1988; 78(Suppl) I91-6.
• 13. Skoularigis J, Sinovich V, Joubert G,Sareli P. Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation 1994 ; 90:167-74.
• 14. Niederhauser U, Carrel T, Von Segesser LK, et al. Reoperation after mitral valve reconstruction: early and late results. Eur J Cardiothorac Surg 1993;7:34-7.