tation, the selection process, and establishment of a new technique and team. Comparison of outcome to the Australaisan and European Registries will also be discussed.
uating new utilities for the treatment of isolated valve disease in the future.
Longterm Results of Mitral Valve Repair with Local Suture Annuloplasty
Resource Utilisation and Long Term Survival for Isolated Aortic Valve Replacement
Jia-Lin Soon 1,2,∗ , Shirley Upton 1 , Xu-Yu Jin 3 , Ravi Pillai 1
Ali Alizzi ∗ , Sameet Pathak, Jayme Cullen, Phillip Tully, Robert A. Baker
Cardiac and Thoracic Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia Introduction: Aortic valve disease, whether in isolation or associated with coronary artery disease is a common condition with substantial morbidity and mortality. New percutaneous aortic valve techniques have provided the impetus to re-examine the costs and long term outcomes of isolated aortic valve procedures. The aim of this retrospective evaluation was to evaluate resource utilisation and long term survival in isolated aortic valve replacement (AVR) surgery. Methods: The surgical cohort included all patients having cardiac surgery for isolated AVR between 1997 and 2007 at Flinders Medical Centre, Flinders Private Hospital and Ashford Community Hospital. Patients were stratiﬁed by age and risk assessed by Euroscore, resource utilisation (intubation hours, intensive care stay, length of say and postoperative length of stay) from prospective data collection and survival status was determined using National Death Index data from the Australian Institute of Health Welfare. Results: We identiﬁed 736 patients having undergone isolated AVR. The median age of patients was 70 years (interquartile range 56–77), and there were 3340 person years of survival for analysis with a median follow-up of 4.3 years (interquartile range 2.4–6.7 years). Overall 5 and 10year survival for the group were 77% and 49%, respectively. Among the 152 deceased AVR patients (20.7% of total) the median survival was 3.3 years (interquartile range 1.2–5.5 years). There were 37 (5.0% of total) patients over 85, with a 5-year survival of 42%. Sixteen (43%) were deceased with a median survival of 0.83 years (interquartile range .11–3.6 years). There were 35 (4.8% of total) patients identiﬁed with a EuroScore >20 with a 5-year survival of 78%. Thirteen (37%) were deceased with a median survival of 1.1 years (interquartile range .07–3.2 years). Hazard modeling with risk adjustment for EuroScore and stratiﬁcation by age showed that EuroScore was associated with survival [hazard ratio 1.03: 95% CI 1.01–1.06; p < .01]. Complete resource utilisation statistics were available on 511 patients. Resource utilsation was signiﬁcantly higher in patients with Euroscore greater than 20 or of increased age. Discussion: This study reports contemporary data on isolated valve procedures which will aid clinicians in eval-
1 Department of Cardiothoracic Surgery, Oxford John Radcliffe
Hospital, Oxford, United Kingdom 2 Department of Cardiothoracic Surgery, National Heart Centre,
Singapore 3 Department
of Surgical Echo-cardiology, Oxford John Radcliffe Hospital, Oxford, United Kingdom Introduction: Conventional mitral valve repair strategies incorporate prosthetic mitral annuloplasty. We report the longterm results of mitral valve repair with limited local suture annuloplasty performed by a single surgeon (RP). Methods: One-hundred-twenty-eight consecutive mitral valve repairs with quadrangular resections of prolapsed posterior leaﬂet and local suture annuloplasty were performed between March 1991 to July 2009 for mitral regurgitation. All patients were retrospectively reviewed and clinical status updated via telephone. Echocardiographic reports were retrieved from our local/regional hospital databases. Median patient age was 68.0 ± 10.0 (30–84 years) with 81 (63.3%) males. Mean left ventricular ejection fraction was 63.3 ± 10.7% (25–80%), logistic Euroscore was 4.8 ± 4.0 (1.5–30.3). The etiology of the mitral regurgitation were: Ninetyfour (73.4%) ﬁbroelastic degenerative, 26 (20.3%) myxomatous, 7 (5.5%) infective endocarditis, and single post-infarct papillary rupture. Three patients underwent resternotomies. Concurrent surgeries include: Fifteen (11.8%) coronary bypass (CABG), 1 (0.8%) aortic valve replacement (AVR), 1 radiofrequency maze, 1 CABG/AVR and 1 aortic arch replacement with stage I elephant trunk. Results: Thirty-day mortality was 0.8% (1 patient). At median follow-up of 4.7 ± 4.9 years (0.01–18.29 years), there were 13 (10.2%) reoperations (single re-repair). Reoperation rate is 4.7% (5 patients including the single re-repair) for the most recent 107 patients subsequent to technical modiﬁcation. Ten-year freedom-from-moderate severity MR is 91%. Overall actuarial 1-, 5-, 10-, and 15-year survival was 98%, 90%, 72% and 53% respectively. The freedom-fromreoperation was 98%, 94%, 87% and 79% at 1, 5, 10, and 15 years. The freedom-from-reoperation of the most recent 107 patients was superior: 100%, 96%, 94% and 90% at 1, 5, 10, and 14 years. Discussion: We report acceptable longterm results of mitral valve repair with quadrangular resection and local suture plication annuloplasty in this select group of patients with prolapsed posterior leaﬂet. doi:10.1016/j.hlc.2010.10.015
Heart, Lung and Circulation 2011;20:35–67