Clinical manifestations and results of reconstructive surgeries in patients with primary and secondary mitral insufficiency

Abstract

Mitral valve reconstruction has become a priority option for mitral regurgitation correction, due to the documented advantages, comparing with valve replacement, in terms of long-term survival, absence of valve-related side effects, and preservation of left ventricle function. Improvement of mitral valve reconstruction techniques has made almost all lesion variants (more than 95 %) suitable for reconstruction, with a 15-year freedom from reoperations in 90 % of all operated patients. Aim. To study clinical manifestations and results of reconstructive surgeries on the mitral valve in patients with primary and secondary mitral regurgitation. Materials and methods. The study is based on the analysis of clinical data of 218 patients with mitral valve insufficiency who were treated in National M. Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2010 to 01.01.2015. The average age of patients was 52.8 ± 13.0 years (16.0–78.0). The ratio of male to female patients was 151 (69.3 %) and 67 (30.7 %) cases, respectively. Acute occurrence of mitral regurgitation was observed in 10 (4.6 %) cases. Results. According to the clinical and histological causes of mitral regurgitation, we systematized and conducted a comparative analysis between groups of patients with primary (n = 174) and secondary (n = 44) mitral regurgitation. The group with primary mitral regurgitation (n = 174) in the early postoperative period was characterized by averagely shorter duration of the total time of artificial ventilation compared with the secondary genesis of mitral regurgitation. Thus, in the group of patients with secondary mitral regurgitation significantly (P = 0.003) more often there were signs of acute cardiac insufficiency. Hospital mortality for the whole group of patients was 5 (2.3 %) cases. In the group with secondary mitral regurgitation, hospital mortality was significantly higher and amounted to – 6.8 % (3 cases in 44 patients), against 1.2 % (2 cases in 174 patients) in primary mitral regurgitation. Conclusions. Primary mitral regurgitation occurs due to a violation of the anatomy of the valvular apparatus, accompanied by increased mobility of the valves (prolapse) and regurgitation. Hospital mortality in primary mitral regurgitation was 1.2 %. Survival after 6 months and by the end of 1 and 5 years was 98.8 %, 98.2 % and 97.0 %, respectively. Secondary mitral regurgitation is caused by the initial dilatation of the left ventricle with preserved anatomy of the valvular apparatus. Hospital mortality was 6.8 %. Survival rate after 6 months, by the end of 1, 3 and 5 years, was 90.9 %, 86.3 %, 77.9 % and 74.0 % respectively.

Keywords

• mitral insufficiency
• reconstructive surgery
• mitral regurgitation