Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): long-term results.

摘要: Background: Previous publications have stressed the benefits of mitral valve repair over replacement in children. However, few communications reported long-term results and none with a follow-up more than 10 years. This article reports our series 145 patients operated on for congenital insufficiency by means same technique (Carpentier's technique) single center. Methods: Between 1970 1995, younger 12 years old underwent surgery insufficiency. Mean age was 5.7 ± 3.1 years, ranging from 0.17 to Mitral associated atrioventricular defect, discordance, straddling valve, acquired diseases, Marfan syndrome, degenerative disease excluded this study. According Carpentier classification, 31 had type I (normal leaflet motion), 79 II (leaflet prolapse), 35 III (restricted 15 having normal papillary muscles 20 abnormal muscles. Associated lesions were present 51 (35%). A conservative operation possible 138 (95%). Among them, 70 required prosthetic annuloplasty 21 extension pericardial patch. Valve necessary seven (5%). Results: In-hospital mortality 5% (95% CL: 2.5% 9.9%) (seven patients). No early death observed group who valvular replacement. as follows: I, 9.6%; II, 2.5%; III, 13%. statistically significant difference noted among different types disease. 9.3 6.9 (1 26 years), cumulative 1142 patient-years. Ten late deaths occurred. Actuarial survival at 88% 51% Late reoperation 15% (n = 21) undergone 28% 2) Causes recurrent left ventricular failure 1), residual or 17), stenosis 3), calcification bioprosthesis 2). resulting observed. In group, actuarial freedom 68% 80.5% 51.5%) linearized rate exposure 1.9% per patient-year. thromboembolic event any group. Conclusion: Congenital can be repaired infancy low mortality. Conservative Carpentier's techniques is feasible majority cases offers stable reoperation. Leaflet ring could prevent reoperations selected cases.