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

Abstract

Baggrund og formål: Mitral insufficiens er den næst hyppigste hjerteklapsygdom og behandles oftest med mitralplastik, fx Alfieri-plastik, fremfor udskiftning af klappen. I dette studie undersøges de tidlige resultater efter Alfieri plastik ved Aalborg Universitets Hospital og sammenlignes med internationale studier. Metode: Præ-, peri- og post-operative data blev indsamlet på patienter der havde fået en Alfieri plastik mellem september 2015 og september 2020. Data blev indsamlet fra Vestdansk Hjertedatabase og den elektroniske patient journal. En deskriptiv statistisk analyse blev lavet på data og præ- og postoperative resultater sammenlignet med en parret t-test blev ved et signifikansniveau på p<0.05. Mortalitetsraten blev beskrevet ud fra en Kaplan-Meier kurve. Resultater: I alt 43 patienter blev inkluderet I dette studie og alle havde moderat (7.0%) eller svær (93.0%) mitralinsufficiens forårsaget af myxomatøs degeneration. Gennemsnitsalderen var 70.91 år (±7.82), og 22 patienter (51.2%) havde en NYHA score på I eller II. I alt 38 af patienterne (88.4%) havde komorbiditeter, oftest hypertension (60.5%) og atrieflimren (58.1%). Hos 23 patienter (53.5%) opstod postoperative komplikationer, oftest atrieflimren (32.6%). Kun 3 patienter (7.0%) havde rest-insufficiens og 38 patienter (90.5%) havde en NYHA score på I eller II postoperativt. To patienter blev reopererede (4.7%) og 6 patienter (14%) blev genindlagte indenfor 30 dage. Konklusion: Den hjerte-lungekirurgiske afdeling ved Aalborg Universitetshospital, Danmark, har samme postoperative resultater som rapporteret i internationale studier, uanset den opererende kirurg. Dog vil en længere opfølgningsperiode, større studiepopulation og en femårs postoperativ klinisk opfølgning være eftertragtet, for mere præcise og sene resultater.

Background and objectives: Mitral regurgitation (MR) is the second most common valve disease, and it is increasingly treated with mitral valve repair e.g., Alfieri repair in favour of valve replacement. In this study, short term results after an Alfieri repair from Aalborg University Hospital are compared with international results. Methods: Pre-, peri- and post-operative data were collected from patients receiving an Alfieri repair between September 2015 and September 2020. Data were collected from the Western Danish Heart Registry and the electronic patient records. A descriptive statistical analysis was performed on all data and a paired t-test was used when comparing pre- and post-operative results with a level of significance at p<0.05. Mortality rate was determined using a Kaplan-Meier estimate. Results: A total of 43 patients were included in this study and all had moderate (7.0%) to severe (93.0%) MR caused by myxomatous degeneration. Mean age was 70.91 years (± 7.82), 22 patients (51.2%) had a NYHA score of I or II and 38 patients (88.4%) had comorbidities, most commonly hypertension (60.5%) and AF (58.1%). A total of 53.5% had postoperative complications, most commonly AF (32.6%). Postoperatively only three patients (7.0%) had residual MR, and 90.5% had NYHA I or II. Freedom of reoperation was 95.3% and readmission within 30 days was 14.0%. Conclusion: The short term results at the Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark, concerning mortality, occurrence of reoperation and readmission within 30 days after Alfieri repair is similar to those reported in international studies. However, a longer follow-up period, larger study population and five-year post-operative clinical follow-up, is to be desired for more precise and long-term results.

A master thesis from Aalborg University

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