Five Year Experience of Mitral Valve Repair Surgery at Armed Force Institute of Cardiology

Abstract

Objective: Experience of the conventional and a de novo Mitral repair techniques for the treatment of Severe Mitral Regurgitation (MR) in a Tertiary Care Cardiac Hospital of Pakistan.
 Study Design: Descriptive cross sectional
 Place and Duration of Study: Cardiac Surgical Division, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan
 Methodology: This was a cross sectional study conducted over a period of 5 years from 2016 to 2020, which included SeventyFive (n=75) patients in the trial, 55 females and 20 males. The mean age was 23±9.5 years (range from 16 to 52 years). Amongst all cases of mitral regurgitation (MR) were five (6%) myxomatous degenerative changes, three (4%) ischemic MR & Sixtyseven (91%) patients had rheumatic aetiology. Five (05) patients with myxomatous diseases required only ring annuloplasty. In patients with ischemic MR, two required chordal shortening for anterior leaflet resuspension, and one required quadrangular resection of the posterior leaflet. Restrictive annuloplasty±Coronary Artery Bypass Grafting (CABG) was alsoperformed as part of the procedures. Sixty-seven (91%) patients having severe Mitral Regurgitation with rheumatic aetiology, required a myriad of procedures; including neo-chordae suspension for anterior & posterior mitral leaflets, quadrangular resection & reattachment of the posterior mitral leaflet. A novel innovative procedure, “Posterior annulus-sliding-plasty” (Nasir’s Technique) was adopted in patients with relatively fixed posterior mitral leaflet. Semi-rigid rings (Carbomedics® or Medtronic CG future®) were used in all the patients to stabilize our repair.
 Results: There was no operative mortality. Patients were followed up for 01-year. Most of the patients have been found to have adequate intact Mitral Valve Repair. Only 01 patient developed Grade-II MR after 06 months (ischemic aetiology). This patient is being followed up at 06 monthly intervals with transthoracic echo and is being treated as per guideline-directed medical therapy (GMDT) for functional MR.
 Conclusion: Mitral Valve Repair in the carefully selected subset of patients with severe MR, irrespective of aetiology can effectively be treated with satisfactory short-term and medium-term results.