Læknablaðið - 01.11.2014, Blaðsíða 16

584 LÆKNAblaðið 2014/100
ENGLISH SUMMARY
Objectives: To review, for the first time, the outcome of mitral valve
repair operations in Iceland.
Material and methods: A retrospective study of all mitral valve repair
patients (average age 64 yrs, 74% males) operated in Iceland 2001-2012.
All 125 patients had mitral regurgitation; either due to degenerative
disease (56%) or functional regurgitation (44%). Survival was estimated
using the Kaplan-Meier method. The median follow-up time was 3.9
years
Results: The number repair-procedures increased from 39 during the
first half of the study period to 86 during the latter period. The mean
EuroSCORE was 12.9% and 2/3 of the patients were in NYHA class
III/IV. Half of them had severe mitral regurgitation, 12% had a recent
myocardial infarction, and 10% a history of previous cardiac surgery.
A ring annuloplasty was performed in 98% of cases, a posterior leaflet
resection was done in 51 patients (41%), 28 received artificial chordae
(Goretex®) and 7 an Alfieri-stitch. Concomitant cardiac surgery was per-
formed in 83% of cases, where coronary artery bypass (53%), Maze-
procedure (31%) or aortic valve replacement (19%) were most common.
Major complications occurred in 56% of the cases and minor complica-
tions were noted in 71% of cases. Two patients later required mitral valve
replacement. Eight patients died within 30 days (6%) and 5-year overall
survival was 79%; or 84% and 74% for the degenerative and functional
groups, respectively.
Conclusions: The number of mitral valve repairs in Iceland increased
significantly over the study period. Complications are common but
operative mortality and long-term survival is similar to that reported in
studies from other countries.
Surgical outcome of mitral valve repair in iceland 2001-2012
Johanna Frida Gudmundsdottir1, Sigurdur Ragnarsson3, Arnar Geirsson1, Ragnar Danielsen2 , Tomas Gudbjartsson1,4
1Departments of Cardiothoracic Surgery & 2Cardiology, Landspitali University Hospital, Reykjavik, Iceland, 3Department of Cardiothoracic Surgery Skane University Hospital, Lund,
Sweden, 4Faculty of Medicine, University of Iceland.
key words: Mitral valve repair, mitral valve prolaps, mitral valve regurgitation, concomitant heart surgery.
Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is
R a n n S Ó k n
Heimildir
1. Iung B, Vahanian A. Epidemiology of valvular heart
disease in the adult. Nat Rev Cardiol 2011; 8: 162­72.
2. Enriquez­Sarano M, Akins CW, Vahanian A. Mitral
regurgitation. Lancet 2009; 373: 1382­94.
3. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu
BA, Tribouilloy C, et al. European Association of
Echocardiography recommendations for the assessment
of valvular regurgitation. Part 2: mitral and tricuspid
regurgitation (native valve disease). Eur J Echocardiogr
2010; 11: 307­32.
4. Enriquez­Sarano M, Freeman WK, Tribouilloy CM,
Orszulak TA, Khandheria BK, Seward JB, et al. Functional
anatomy of mitral regurgitation: accuracy and outcome
implications of transesophageal echocardiography. J Am
Coll Cardiol 1999; 34: 1129­36.
5. Monin JL, Dehant P, Roiron C, Monchi M, Tabet JY, Clerc
P, et al. Functional assessment of mitral regurgitation by
transthoracic echocardiography using standardized imag­
ing planes diagnostic accuracy and outcome implications.
J Am Coll Cardiol 2005; 46: 302­9.
6. Joint Task Force on the Management of Valvular
Heart Disease of the European Society of C, European
Association for Cardio­Thoracic S, Vahanian A, Alfieri O,
Andreotti F, Antunes MJ, et al. Guidelines on the manage­
ment of valvular heart disease (version 2012). Eur Heart J
2012; 33: 2451­96.
7. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ,
Fail PS, et al. Percutaneous repair or surgery for mitral
regurgitation. N Engl J Med 2011; 364: 1395­406.
8. Carpentier A. Cardiac valve surgery­­the „French correc­
tion“. J Thorac Cardiovasc Surg 1983; 86: 323­37.
9. Adams DH, Rosenhek R, Falk V. Degenerative mitral
valve regurgitation: best practice revolution. Eur Heart J
2010; 31: 1958­66.
10. Spoor MT, Geltz A, Bolling SF. Flexible versus nonflexible
mitral valve rings for congestive heart failure: differential
durability of repair. Circulation 2006; 114(1 Suppl): I67­71.
11. Enriquez­Sarano M, Schaff HV, Orszulak TA, Tajik AJ,
Bailey KR, Frye RL. Valve repair improves the outcome of
surgery for mitral regurgitation. A multivariate analysis.
Circulation 1995; 91: 1022­8.
12. Amirak E, Chan KM, Zakkar M, Punjabi PP. Current status
of surgery for degenerative mitral valve disease. Prog
Cardiovasc Dis 2009; 51: 454­9.
13. Gillinov AM, Blackstone EH, Nowicki ER, Slisatkorn
W, Al­Dossari G, Johnston DR, et al. Valve repair versus
valve replacement for degenerative mitral valve disease. J
Thorac Cardiovasc Surg 2008; 135: 885­93, 93: e1­2.
14. Ragnarsson S, Sigurdsson MI, Danielsen R, Arnorsson
T, Gudbjartsson T. Árangur míturlokuskipta á Íslandi.
Læknablaðið 2012; 98: 203­9.
15. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow
S, Salamon R. European system for cardiac operative risk
evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;
16: 9­13.
16. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C,
Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac
Surg 2012; 41: 734­44; discussion 44­5.
17. Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin
JS, O‘Brien SM, et al. Trends in mitral valve surgery in
the United States: results from the Society of Thoracic
Surgeons Adult Cardiac Surgery Database. Ann Thorac
Surg 2009; 87: 1431­7; discussion 7­9.
18. Kang DH, Kim JH, Rim JH, Kim MJ, Yun SC, Song JM,
et al. Comparison of early surgery versus conventional
treatment in asymptomatic severe mitral regurgitation.
Circulation 2009; 119: 797­804.
19. David TE, Ivanov J, Armstrong S, Rakowski H. Late outco­
mes of mitral valve repair for floppy valves: Implications
for asymptomatic patients. J Thorac Cardiovasc Surg 2003;
125: 1143­52.
20. David TE, Armstrong S, McCrindle BW, Manlhiot C. Late
outcomes of mitral valve repair for mitral regurgitation
due to degenerative disease. Circulation 2013; 127: 1485­
92.
21. Di Salvo TG, Acker MA, Dec GW, Byrne JG. Mitral valve
surgery in advanced heart failure. J Am Coll Cardiol 2010;
55: 271­82.
22. Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui
N, Markus KU, Franke A, et al. Acute effects of cardiac
resynchronization therapy on functional mitral regurgita­
tion in advanced systolic heart failure. J Am Coll Cardiol
2003; 41: 765­70.
23. Fattouch K, Guccione F, Sampognaro R, Panzarella G,
Corrado E, Navarra E, et al. POINT: Efficacy of adding
mitral valve restrictive annuloplasty to coronary artery
bypass grafting in patients with moderate ischemic
mitral valve regurgitation: a randomized trial. J Thorac
Cardiovasc Surg 2009; 138: 278­85.
24. McGee EC, Gillinov AM, Blackstone EH, Rajeswaran J,
Cohen G, Najam F, et al. Recurrent mitral regurgitation
after annuloplasty for functional ischemic mitral regur­
gitation. J Thorac Cardiovasc Surg 2004; 128: 916­24.
25. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES,
Cosgrove DM, White J, et al. Is repair preferable to
replacement for ischemic mitral regurgitation? J Thorac
Cardiovasc Surg 2001; 122: 1125­41.
26. Lorusso R, Gelsomino S, Vizzardi E, D‘Aloia A, De Cicco
G, Luca F, et al. Mitral valve repair or replacement for
ischemic mitral regurgitation? The Italian Study on the
Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J
Thorac Cardiovasc Surg 2013; 145: 128­39; discussion 37­8.
27. Acker MA, Parides MK, Perrault LP, Moskowitz AJ,
Gelijns AC, Voisine P, et al. Mitral­Valve Repair versus
Replacement for Severe Ischemic Mitral Regurgitation. N
Eng J Med 2014; 370: 23­32.
28. Ingvarsdottir IL, Viktorsson SA, Hreinsson K, Sigurdsson
MI, Helgadottir S, Arnorsson P, et al. Lokuskipti vegna
ósæðarlokuþrengsla á Íslandi 2002­2006: ábendingar og
snemmkomnir fylgikvillar. Læknablaðið 2011; 97: 523­7.
29. Oddsson SJ, Sigurjonsson H, Helgadottir S, Sigurdsson
MI, Viktorsson SA, Arnorsson T, et al. Tengsl offitu við
árangur kransæðahjáveituaðgerða. Læknablaðið 2011; 97:
223­8.
30. Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik
JA, Enriquez­Sarano M. Very long­term survival and
durability of mitral valve repair for mitral valve prolapse.
Circulation 2001; 104 (12 Suppl 1): I1­I7.
Fyrsti örvinn við einkennum ofvirkrar þvagblöðruß -
3
Heimildir: 1. Khullar et al. European Urology 63;(2013):283–295.
2. Nitti et al. J Urol 2013;189:1388–1395.
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