Short term results after an Alfieri repair in treatment of mitral regurgitation

Mørk, Kasper ; Baban, Rana

5. Term (Master thesis)

Medicine, Master

2021

2021-01-05

19

Mitral regurgitation is a leak in the heart’s mitral valve and is the second most common valve disease. Increasingly, doctors repair the valve rather than replace it; a widely used technique is the Alfieri repair. This study reports short‑term results for patients who had an Alfieri repair at Aalborg University Hospital and compares them with international findings. We reviewed data before, during, and after surgery for all patients who underwent an Alfieri repair from September 2015 to September 2020. Information came from the Western Danish Heart Registry and hospital records. We described patient characteristics and compared health status before and after surgery using standard statistical tests. Survival over time was estimated using a Kaplan‑Meier method. Forty‑three patients were included; all had moderate (7.0%) to severe (93.0%) mitral regurgitation due to myxomatous degeneration of the valve. The average age was 70.9 years. Most had other illnesses, especially hypertension (60.5%) and atrial fibrillation (58.1%). At baseline, 51.2% had mild symptoms (NYHA class I–II). After surgery, 53.5% experienced complications, most often atrial fibrillation (32.6%). Only three patients (7.0%) had residual leakage across the valve, and 90.5% were in NYHA class I–II. Freedom from reoperation was 95.3%, and 14.0% were readmitted within 30 days. Overall, short‑term outcomes at Aalborg—mortality, need for reoperation, and 30‑day readmissions—were comparable to those reported internationally. Larger studies with longer follow‑up, including five‑year clinical assessment, are needed to clarify long‑term results.

Mitral regurgitation er en utæthed i hjertets mitralklap og er den næsthyppigste klapsygdom. I stigende grad reparerer man klappen i stedet for at udskifte den; en udbredt metode er Alfieri‑reparation. Dette studie beskriver korttidsresultater for patienter, der fik en Alfieri‑reparation på Aalborg Universitetshospital, og sammenligner dem med internationale resultater. Vi gennemgik data før, under og efter operationen for alle patienter, der fik en Alfieri‑reparation fra september 2015 til september 2020. Oplysningerne kom fra Vestdansk Hjerteregister og elektroniske journaler. Vi beskrev patienternes forhold og sammenlignede helbred før og efter operationen med standard statistiske metoder. Overlevelse over tid blev beregnet med et Kaplan‑Meier‑estimat. I alt indgik 43 patienter; alle havde moderat (7,0%) til svær (93,0%) mitral regurgitation pga. myxomatøs degeneration af klappen. Gennemsnitsalderen var 70,9 år. De fleste havde andre sygdomme, især hypertension (60,5%) og atrieflimren (58,1%). Ved baseline havde 51,2% få symptomer (NYHA klasse I–II). Efter operationen havde 53,5% komplikationer, oftest atrieflimren (32,6%). Kun tre patienter (7,0%) havde restlækage, og 90,5% var i NYHA klasse I–II. 95,3% havde ikke behov for reoperation, og 14,0% blev genindlagt inden for 30 dage. Samlet set var korttidsresultaterne på Aalborg—dødelighed, behov for reoperation og 30‑dages genindlæggelser—på linje med internationale opgørelser. Større studier med længere opfølgning, herunder fem års klinisk kontrol, er ønskelige for at belyse langtidsresultaterne.

[This apstract has been rewritten with the help of AI based on the project's original abstract]

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