Evolution of reparative surgery for mitral incompetence. History, techniques and results

Abstract

La valvulopatia mitralica su base degenerativa rappresenta oggi una importante causa di insufficienza valvolare. In questi pazienti gli interventi riparativi sono attualmente eseguiti con ottimi risultati immediati ed a distanza. Presso la Cardiochirurgia pisana, in un periodo compreso fra gennaio 2004 e dicembre 2016, 242 pazienti sono stati sottoposti ad intervento riparativo della valvola mitrale per vari gradi di insufficienza. La rivalutazione a distanza dei sopravvissuti a lungo termine ha confermato come la sopravvivenza e la libertà da reintervento (75 ± 3% e 96 ± 3%, rispettivamente nella nostra casistica a 10 anni) siano in linea con le più ampie casistiche riportate in letteratura e come l’intervento ripartivo nella insufficienza mitralica su base degenerativa sia sostanzialmente a basso rischio, riproducibile e stabile nel tempo. Per tali motivi questa procedura deve essere presa in considerazione ogni qualvolta l’anatomia valvolare lo consenta e comunque vada tentata anche nelle patologie più complesse prima di procedere alla eventuale sostituzione protesica.

Parole chiave: Valvola mitrale; Insufficienza mitralica; Chirurgia riparativa.

Degenerative mitral valvulopathy is currently an important cause of valvular insufficiency. In the past, patients with mitral regurgitation were treated almost exclusively with mitral valve replacement using both mechanical or biological prostheses. Reparative surgery began in the 80s, following the extensive anatomical and functional studies of the mitral valve performed by Alain Carpentier. Mitral valve repair has become in recent years the gold standard in the treatment of degenerative mitral valve insufficiency showing excellent results in terms of late survival and stability of the procedure. At the Cardiac Surgery Unit of the University Hospital of Pisa, between January 2004 and December 2016, 242 patients underwent mitral valve repair procedures for degenerative mitral valve disease. Re-evaluation of long-term survivors has confirmed that survival and freedom of reoperation (75 ± 3% and 96 ± 3%, respectively in our case series after 10 years) are similar to the results reported in larger studies in the current literature. Review of our experience has confirmed that reparative surgery in patients with mitral regurgitation due to degenerative disease can be performed with substantially low risk, it is reproducible and stable over time. For these reasons, this procedure must be taken into consideration whenever the valve anatomy allows it and in should be attempted even in the most complex pathologies before shifting to prosthetic mitral valve replacement.

Key words: Mitral regurgitation; Valve repair; Valve replacement.