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Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair  Douglas R. Johnston, MD, A. Marc Gillinov, MD,

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Presentation on theme: "Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair  Douglas R. Johnston, MD, A. Marc Gillinov, MD,"— Presentation transcript:

1 Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair  Douglas R. Johnston, MD, A. Marc Gillinov, MD, Eugene H. Blackstone, MD, Brian Griffin, MD, William Stewart, MD, Joseph F. Sabik, MD, Tomislav Mihaljevic, MD, Lars G. Svensson, MD, PhD, Penny L. Houghtaling, MS, Bruce W. Lytle, MD  The Annals of Thoracic Surgery  Volume 89, Issue 5, Pages (May 2010) DOI: /j.athoracsur Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Study population. Of 3,383 patients with isolated posterior leaflet prolapse, mitral valve repair was performed in 96.7%, and 3,074 underwent a standard repair that included quadrangular resection and annuloplasty. These patients represent the study group. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Mean age of patients undergoing repair of posterior leaflet prolapse as a function of time. Closed circles represent yearly age estimates. Solid line is trend line. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Death after mitral valve repair for posterior leaflet prolapse compared with expected survival of an age- and sex-matched US population cohort (dot-dash-dot line). Each circle represents a death, vertical bars are asymmetric 68% confidence limits (CL, equivalent to ± 1 standard error), solid line is parametric estimate enclosed within dashed 68% CLs, and numbers in parentheses are patients remaining at risk. (A) Survival. (B) Hazard function (instantaneous risk) for death. Solid line is hazard estimate enclosed within 68% CLs. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Mitral valve (MV) reoperation after repair of posterior leaflet prolapse. (A) Freedom from reoperation. Format is as in Figure 3A. (B) Hazard function (instantaneous risk) for reoperation. Format is as in Figure 3B. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Predicted 1-year freedom from reoperation according to age at mitral valve repair. Graph is a nomogram of multivariable equation represented by Table 3, with blood urea nitrogen set to 17 mg/dL, hematocrit to 40%, and posterior wall thickness to 1.1 cm. Solid line is parametric estimate, and dashed lines are 68% confidence limits equivalent to ± 1 standard error. Note expanded scale. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Temporal trend in return of postoperative mitral regurgitation (MR). Squares = no MR, open circles = 1+ MR, closed circles = 2+ MR, triangles = 3+/4+ MR. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

8 Appendix B Fig 1 The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions


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