Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS34. Four Decades of Experience with Mitral Valve Repair: Analysisof Differential Indications, Technical Evolution and Long-TermOutcomeDaniel J. DiBardino, Andrew W. ElBardissi, Ann Maloney, R. Scott McClure,Oswaldo Razo-Vasquez, Judah A. Askew, Lawrence H. Cohn *Cardiac Surgery, Harvard Medical School, Boston, MA, USAInvited Discussant: David H. AdamsOBJECTIVE: The objective was to determine the long-term outcome of mitralvalve repair (MVP) in 1,469 patients from 1972 to 2007. We compare performance ofevolving differential repair strategies among MV disease types.METHODS: Patients having MVP by a single surgeon were retrospectivelyreviewed and current survival and reoperation data were collected. Emphasis wason repair strategy and long-term survival/reoperation status by MV disease etiology.RESULTS: There were 1,469 MV repairs since 2/23/1972; overall mean age was 60yrs and 57% were male. Etiologies included 1,010 myxomatous (mean age 60 ± 13yrs, 66% male), 193 rheumatic (mean 55 ± 15 yrs, 85% female), 129 ischemic (mean70 ± 10 yrs) and 93 functional/cardiomyopathic (FCM, mean 67 ±1 1 yrs). Repairstrategies evolved over four decades and included commissurotomy, papillary musclesplitting, leaflet resection with reconstruction and ring annuloplasty, commissuroplasty,fold-o-plasty, Gortex chord creation and edge-to-edge repair. The 30 daymortality was n = 19/1,469 (1.29%) while overall 10, 20 and 30 year actuarial survivalwas 72%, 47% and 35%. Rheumatic and myxomatous actuarial survival wassimilar at 10, 20 and 30 years (77%, 55%, 38% versus 77%, 55%, 27%, respectively)while Cox proportional hazards modeling determined ischemic [Hazard Ratio(HR) 4.671, p < 0.0001] and FCM etiology [HR 3.298, p < 0.0001] as significantpredictors of poor survival. Combined MVP/CABG had decreased survival versusisolated MVP at all time points (61% versus 33% at 20 years, p < 0.0001). Length ofstay was less for right parasternal (5.9 days) and lower mini-sternotomy (6.5 days)than for right thoracotomy (10.9 days) and full sternotomy (8.6 days, p < 0.0001).Overall actuarial 10, 20 and 30 year freedom from reoperation was 84%, 60% and18%; 83% of myxomatous valves remained free from reoperation at 20 years (versus32% of rheumatics) while only 9% of rheumatics remained so at 30 years. Coxproportional hazard estimates of freedom from reoperation found rheumatic disease(HR 18.52, p < 0.001, figure 1) and prolonged cardiopulmonary bypass time (HR1.020, p = 0.0004) among significant predictors of reoperation.* AATS Member160
AMERICAN ASSOCIATION FOR THORACIC SURGERYCONCLUSION: These follow-up data up to 36 years support repair as the procedureof choice for the majority of MV disease. Disease etiology strongly determinessurvival and durability; rheumatics enjoy the longest survival but require reoperationmore frequently. Myxomatous MVP demonstrates the longest proven durability,approaching 30 years postoperatively.11:20 a.m. The Role of Simulation in Future CardiothoracicSurgical EducationDan Raemer, PhD,Yolonda L. Colson, MD, PhDGregory S. Couper MDIntroduced By: Edward Verrier, MD11:50 a.m. ADDRESS BY HONORED SPEAKERThe Creation of the Universe, String Theory, andTime TravelProfessor Michio KakuHenry Semat Professor of Theoretical Physics Graduate Center of theCity University of New YorkIntroduced By: Thomas L. Spray, MD12:30 p.m. ADJOURN FOR LUNCH – VISIT EXHIBITSExhibit HallTUESDAYMorning161
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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