Skip to main content
SpringerLink
Log in

Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus

Echokardiographische und klinische Evaluation im Langzeitverlauf

Mitral valve surgery in patients with extensively calcified mitral annulus

Long-term echocardiographic and clinical follow-up

  • Originalarbeit
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Ziel

Untersuchung der Ergebnisse bei Patienten mit wirksamen Mitralvitium bei schwer verkalktem Mitralring nach Dekalzifizierung und Patch-Rekonstruktion im Langzeitverlauf.

Patienten und Methoden

Von 1996 bis 2008 wurden 109 Patienten mit schwer verkalktem Mitralring aufgrund schwerer Mitralinsuffizienz (MI) oder Mitralstenose (MS) operiert. Das durchschnittliche Alter der Patienten (65 Frauen, 44 Männer) lag bei 66,4±13,8 Jahren. 53 Patienten (49%) erhielten eine Mitralklappenrekonstruktion (MKR), 56 Patienten (51%) einen Mitralklappenersatz (MKE). Bei 64 Patienten (59%) wurden Begleiteingriffe durchgeführt. Die mittlere Follow-up-Zeit betrug 96±48 Monate.

Ergebnisse

Die Früh- und Spätmortalität betrug 8,3% (9 Patienten) bzw. 25,6% (28 Patienten). Die 5-, 8- und 12-Jahres-Überlebensraten lagen bei 88,1%, 76,2% und 66,1%. Das echokardiographische Follow-up zeigte bei 4 Patienten (6%) eine Mitralinsuffizienz Grad III; keiner der Patienten hatte eine Mitralinsuffizienz Grad IV. Wir beobachteten eine signifikante Reduktion der Größe des linken Vorhofs, des LVEDD und des mittleren transvalvulären Druckgradienten. Die Freiheit von Reoperation lag nach 5 und 8 Jahren bei 96,4% bzw. 91,8%. Risikofaktoren für eine signifikant erhöhte Früh- oder Spätmortalität waren arterielle Hypertension, Diabetes mellitus, Alter über 65 Jahre, zusätzlicher Aortenklappenersatz, Begleiteingriffe, chronisches Nierenversagen sowie kardiale Dekompensation in der Vorgeschichte.

Schlussfolgerung

Die Langzeitergebnisse dieser Studie zeigen, dass eine Dekalzifizierung und Patch-Rekonstruktion bei schwer verkalktem Mitralring auf zufriedenstellende Weise bei Hochrisikopatienten durchgeführt werden kann.

Abstract

Objective

The aim of this study was the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensively calcified mitral annulus who underwent decalcification and patch reconstruction.

Patients and Methods

Between 1996 and 2008 a total of 109 patients underwent surgery for extensive calcification and severe mitral insufficiency and mitral stenosis. The mean age of the patients (65 women and 44 men) was 66.4±13.8 years. In 53 patients (49%) mitral valve repair was performed and the remaining 56 patients (51%) received a mitral valve replacement. Of the patients 64 (59%) required concomitant surgery. The mean follow up time was 96±48 months.

Results

The in-hospital and late mortality was 8.3% (9 patients) and 25.6% (28 patients), respectively. The actuarial survival rates at 5, 8 and 12 years were 88.1%, 76.2% and 66.1%, respectively. Echocardiographic follow-up presented a mitral insufficiency grade III in 4 patients (6%). None of the patients had a mitral insufficiency grade IV. A significant reduction of left atrium diameter, of the LVEDD as well as the mean transvalvular gradient was observed. Freedom from reoperation at 5 and 8 years was 96.4% and 91.8%, respectively. Systemic hypertension, diabetes mellitus, age older than 65 years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history were found to be predictors for significantly increased early or late mortality.

Conclusion

The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high risk patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. D’Alessandro C, Vistarini N, Aubert S et al (2007) Mitral annulus calcification: determinants of repair feasibility, early and late surgical outcome. Eur J Cardiothorac Surg 32:596–603

    Article  Google Scholar 

  2. Savage DD, Garrison RJ, Castelli WP et al (1983) Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study). Am J Cardiol 51:1375–1378

    Article  PubMed  CAS  Google Scholar 

  3. Carpentier AF, Pellerin M, Fuzellier JF, Relland JY (1996) Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg 111:718–729

    Article  PubMed  CAS  Google Scholar 

  4. Moritz A, Dogan S, Aybek T et al (1999) Komplexe minimal invasive Mitralklappenchirurgie. Z Kardiol 88:IV/24–IV/29

    Article  Google Scholar 

  5. Papadopoulos N, Dietrich M, Christodoulou T et al (2009) Midterm survival after decalcification of the mitral annulus. Ann Thorac Surg 87:1143–1147

    Article  PubMed  Google Scholar 

  6. Dietrich M, Doss M, Aybek T et al (2006) Decalcification of the mitral annulus: surgical experience in 81 patients. Thorac Cardiovasc Surg 54:464–467

    Article  PubMed  CAS  Google Scholar 

  7. Cammack PL, Edie RN, Edmunds LH Jr (1987) Bar calcification of the mitral anulus. A risk factor in mitral valve operations. J Thorac Cardiovasc Surg 94:399–404

    PubMed  CAS  Google Scholar 

  8. D’Cruz IA, Cohen HC, Prabhu R et al (1977) Clinical manifestations of mitral annulus calcification, with emphasis on its echocardiographic features. Am Heart J 94:367–377

    Article  Google Scholar 

  9. Delahaye JP, Gevigney G de, Garé JP et al (1991) Results of surgery in mitral valve insufficiency with impaired left ventricular function. Arch Mal Coeur Vaiss 84:19–24

    PubMed  CAS  Google Scholar 

  10. Gummert JF, Rahmel A, Bucerius J et al (2003) Mitral valve repair in patients with end stage cardiomyopathy: who benefits? Eur J Cardiothorac Surg 23:1017–1022

    Article  PubMed  Google Scholar 

  11. Glower DD, Tuttle RH, Shaw LK et al (2005) Patient survival characteristics after routine mitral valve repair for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 129:860–868

    Article  PubMed  Google Scholar 

  12. Heikkinen J, Biancari F, Satta J et al (2005) Predictors of postoperative mortality after mitral valve repair: analysis of a series of 164 patients. Scand Cardiovasc J 39:71–77

    Article  PubMed  Google Scholar 

  13. Accola KD, Scott ML, Thompson PA et al (2005) Midterm outcomes using the physio ring in mitral valve reconstruction: experience in 492 patients. Ann Thorac Surg 79:1276–1283

    Article  PubMed  Google Scholar 

  14. Rahimtoola SH (2003) Choice of prosthetic heart valve for adult patients. J Am Coll Cardiol 41:893–904

    Article  PubMed  Google Scholar 

  15. Reece TB, Tribble CG, Ellman PI et al (2004) Mitral repair is superior to replacement when associated with coronary artery disease. Ann Surg 239:671–675

    Article  PubMed  Google Scholar 

  16. Feindel CM, Tufail Z, David TE et al (2003) Mitral valve surgery in patients with extensive calcification of the mitral annulus. J Thorac Cardiovasc Surg 126:777–782

    Article  PubMed  Google Scholar 

  17. Ng CK, Punzengruber C, Pachinger O et al (2000) Valve repair in mitral regurgitation complicated by severe annulus calcification. Ann Thorac Surg 70:53–58

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Herz-, Thorax- und Thorakale Gefäßchirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    K. Steuer, N. Papadopoulos, A. Moritz &  M. Doss

Authors
  1. K. Steuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Papadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Moritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Doss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Doss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steuer, K., Papadopoulos, N., Moritz, A. et al. Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus . Herz 37, 762–769 (2012). https://doi.org/10.1007/s00059-011-3576-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-011-3576-7

Schlüsselwörter

Keywords

Search

Navigation