The aim of this randomized, prospective, study was to evaluate postoperative hospital mortality and morbidity after mitral valve repair by comparing two surgical techniques for resolving mitral valve insufficiency in elderly patients. In comparison were: mitral valve repair vs. mitral valve replacement in patients older than 70 years. In period from January 1st 2006 until August 30th 2009. Eighty patients with mitral valve disease, isolated or associated with other co morbidities, were scheduled for mitral valve repair or mitral valve replacement in our institution. Patients were randomized in two groups, one scheduled for mitral valve repair and another one for mitral valve replacement using the envelope method with random numbers. Results show no difference in hospital mortality and morbidity postoperatively in both groups. In group undergoing valve replacement we had one significant complication of ventricle rupture in emphatically calcified posterior part of mitral valve annulus. In conclusion we found no distinction in postoperative hospital mortality and morbidity after using one of two surgical techniques

Aldo Ivančić

Boris Zrnić

Darko Anić

Igor Medved

Marin Oštrić

Vjekoslav Tomulić

Hrčak - Portal of scientific journals of Croatia

Coll. Antropol. 34 (2010) Suppl. 2: 213–215Professional paperIs Mitral Valve Repair Safe Procedure in ElderlyPatients?Igor Medved1, Darko Ani}2, Marin O{tri}1, Boris Zrni}1, Aldo Ivan~i}3 and Vjekoslav Tomuli}41 Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia2 Department of Cardiac Surgery, University Hospital Zagreb, Zagreb, Croatia3 Department of Thoracic and Vascular Surgery, University Hospital Rijeka, Rijeka, Croatia4 Department of Cardiology, University Hospital Rijeka, Rijeka, CroatiaA B S T R A C TThe aim of this randomized, prospective, study was to evaluate postoperative hospital mortality and morbidity aftermitral valve repair by comparing two surgical techniques for resolving mitral valve insufficiency in elderly patients. Incomparison were: mitral valve repair vs. mitral valve replacement in patients older than 70 years. In period from Janu-ary 1st 2006 until August 30th 2009. Eighty patients with mitral valve disease, isolated or associated with other co mor-bidities, were scheduled for mitral valve repair or mitral valve replacement in our institution. Patients were randomizedin two groups, one scheduled for mitral valve repair and another one for mitral valve replacement using the envelopemethod with random numbers. Results show no difference in hospital mortality and morbidity postoperatively in bothgroups. In group undergoing valve replacement we had one significant complication of ventricle rupture in emphaticallycalcified posterior part of mitral valve annulus. In conclusion we found no distinction in postoperative hospital mortalityand morbidity after using one of two surgical techniques.Key words: mitral valve disease, repair; replacement, elderly patientsIntroductionIn last decade there is an increasing number of pa-tients older than 70 years scheduled for cardiac surgery1.Mitral valve (MV) repair is an established surgical me-thod for the treatment of mitral insufficiency (MI). MVrepair is more preferred over replacement in younger pa-tients, but in patients over 70 years it is still contro-versial2–4. MV surgery in older people requires greatskills and experience because of cardiac and non-cardiacco morbidities5–7. Older patients often are not scheduledfor MV repair because of co morbidities and perceptionthat they may not tolerate prolonged cardiopulmonarybypass in case of inadequate repair. Elderly patients, inpresumption, do not benefit from MV repair due to shortlife expectancy. Therefore, the objective of this study isfocused on postoperative hospital mortality and morbid-ity after MV repair in elderly.Patients and MethodsAfter obtaining approval from the Medical FacultyEthics Committee and consent from all the patients,eighty consecutive patients older than 70 years with MVinsufficiency were scheduled to undergo MV repair or re-placement from January 1st 2007 to June 30th 2009 in ourinstitution. Patients with previous MV surgical treat-ment, myocardial infarction within 7 days, and youngerthen 70 years were excluded from the study. Both groupswere randomized using the envelope method with randomnumbers. Demographic and clinical profiles of groups arepresented in Table 1. There were no significant differ-ences between two groups in age, sex, weight, height, comorbidities, and medications. General anesthesia (withthe application of propofol, midazolam, atracuronium,and inhaled isofluranum) was facilitated. Heparin wasadministrated in dosage of 3 mg/kg to achieve an acti-213Received for publication January 10, 2010vated clotting time (ACT) >480 sec. Protamine was usedto reverse the effect of heparin at the dose ratio of 1.5:1.Surgical techniqueSurgical access was through a full midline sternotomyon full cardiopulmonary bypass within all cases. Moder-ate systemic hypothermia was used. Anterograde Cala-fiore cardioplegia followed with retrograde cardioplegiawas delivered. MV approach was through the right in-teratrial grove atriotomy. All patients had MV insuffi-ciency grade III-IV. Etiology of MV insufficiency was dif-ferent (myxomatous, rheumatic, ischemic and as anresult of endocarditis). In case of MV insufficiency gradeII due to ischemic etiology, intraoperative dynamic test-ings were made (volume overload in combination withpressure-afterload test). In case of MV insufficiency pro-gresion we performed MV surgery.Statistical analysisData are presented as mean ± standard deviation. Thec2-test and Fisher Exact test were used to compare vari-ables. The nonparametric Mann-Whitney test was usedto calculate the difference between the two groups. Anal-ysis was performed with MedCalc Software (MedCalcInc., Mariakerke, Belgium). A value of p<0.05 was re-quired for significance.ResultsEighty patients were divided in two groups; 40 pa-tients undergoing MV repair and 40 patients undergoingMV replacement. Due to other cardiac pathology, ex-tended surgical procedures were made. Basic demogra-phic and preoperative values were not significantly dif-ferent between groups. Intraoperative ischemic time wassignificantly longer in MV repair group. Number andtype of concomitant procedures were not significantlydifferent between groups (Table 2). Postoperatively onlydifference was in prolonged ventilatory support in MVrepair group (Table 3).DiscussionIn this study we have evaluated postoperative hospi-tal mortality and morbidity after mitral valve surgery,comparing MV repair versus MV replacement in popula-tion older than 70 years. MV disease is an increasingmedical problem mainly due to an ageing population andtreatment of other cardiac diseases8–18. MV replacementis simple and relatively quick operation and has achievedpredictable and good long-term results. Reconstructionof MV, developed and popularized by Carpentier, becamea standard in degenerative mitral regurgitation or dilata-tion of mitral annulus11–14. Although MV repair is timeconsuming (106,75 min of ischemic time in repair groupversus 86,46 min in replacement group) especially in el-derly patients, the overall results are not different. Insome cases the implantation of artificial chordae had tobe added to MV repair to eliminate incompetence, whichwas also, the reason for prolonged ischemic time in re-pair group. We think that prolonged ventilatory supporttime can be associated with prolonged ischemic time.Both did not influence postoperative morbidity and mor-tality.I. Medved et al.: Mitral Valve Repair in Elderly, Coll. Antropol. 34 (2010) Suppl. 2: 213–215214TABLE 1BASELINE DEMOGRAPHIC CHARACTERISTICSVARIABLEMV REPAIRn=40MV REPLACEMENTn=40Age/years 76±5 74.3±3female 3 12smoking 1 1previous IM 4 3hypercholesterolemia 7 9hypertension 7 12ejection fraction 40% 45%Euro-score 16.94 % 15.76%pulmonary diseases 10 8TABLE 2INTRAOPERATIVE DATAVARIABLEMV REPAIRn=40MV REPLACEMENTn=40mean bypass time 130 min 120.06 minmean ischemic time 106.75 min 86.46 minconcomitant procedureCABG 7 10TV anuloplasty 15 12AV replacement 15 10Aortic surgery 2 1RF ablation 21 27TABLE 3POSTOPERATIVE DATAVARIABLEMV REPAIRn=40MV REPLACEMENTn=40myocardial infartion 2 1postoperative CK-Mb(IU/L)30 40bleeding (24 h) 720 mL 650 mLreoperation 0 1respiratory complica-tion5 4time of ventilatorysupport/days15 10.5neurologicdisfunction1 1ICU stay/days 5.2 4.2in-hospital stay/days 15 13.5in-hospital death 2 1After evaluating mitral regurgitation grade>II, usingtransoesophageal echocardiography in operating room,in 3 cases MV replacement was preformed following in-adequate repair.We had 3 in hospital deaths. In MV repair group onepatient died from perioperative myocardial infarction,and other from multiorgan failure. In replacement groupone patient died from rupture of ventricle in emphati-cally calcified posterior part of mitral valve annulus.In summary, there was no difference in any of twotechniques regarding hospital mortality and morbiditypostoperatively. According to our results we think thatMV repair is safe technique when feasible, even in el-derly patients. Experienced surgeon should perform MVrepair to minimize repair failure and prolong bypasstime.R E F E R E N C E S1. TSAI TP, MATLOFF JM, GRAY RJ, CHAUX A, KASS RM, LEEME, CZER LS, J Thorac Cardiovasc Surg, 91 (1986) 924. — 2. DETAINTD, SUNDT TM, NKOMOVT, SCOTT CG, TAJIK AJ, SCHAFFHV, ENRI-QUEZ-SARANOM, Circulation, 114 (2006) 265. — 3. JEBARA VA, DER-VANIAN P, ACAR C, GRARE P, MIHAILEANU S, CHAUVAUD S, FA-BIANI JN, DELOCHE A, CARPENTIER A, Circulation, 86 (1992) 53. —4. AILAWADI G, SWENSON BR, GIROTTI ME, GAZONI LM, PEELERBB, KERN JA, FEDORUK LM, KRON IL, Ann Thorac Surg, 86 (2008)77. — 5. NAGENDRAN J, NORRIS C, MAITLAND A, KOSHAL A, ROSSDB, Eur J Cardiothorac Surg, 28 (2005) 83. — 6. AZAR H, SZENTPE-TERY S, Eur J Cardiothorac Surg, 8 (1994) 298. — 7. SCOTT ML, STO-WE CL, NUNNALLY LC, SPECTOR SD, MOSELEY PW, SCHUMA-CHER PD, THOMPSON PA, Ann Thorac Surg, 48 (1989) 213. — 8.GILLINOV AM, WIERUP PN, BLACKSTONE EH, BISHAY ES,COSGROVE DM, WHITE J, LYTLE BW, MCCARTHY PM, J ThoracCardiovasc Surg, 122 (2001) 1125. — 9. GILLINOV AM, COSGROVEDM, BLACKSTONE EH, DIAZ R, ARNOLD JH, LYTLE BW, SMEDIRANG, SABIK JF, MCCARTHY PM, LOOP FD, J Thorac Cardiovasc Surg,116 (1998) 734. — 10. HICKEYMS, SMITH LR, MUHLBAIER LH, HAR-REL FE, REVES JG, HINOHARA T, CALIFF RM, PRYOR DB, RANKINJS, Circulation, 78 (1988) 51. — 11. BRAUNBERGER E, DELOCHE A,BERREBI A, ABDALLAH F, CELESTIN JA, MEIMOUN P, CHATEL-LIER G, CHAUVAUD S, FABIANI JN, CARPENTIER A, Circulation, 104(2001) 8. — 12. ENRIQUEZ-SARANO M, SCHAFF HV, ORSZULAK TA,TAJIK AJ, BAILEY KR, FRYE RL, Circulation, 91 (1995) 1022. — 13.CARPENTIER A, J Thorac Cardiovasc Surg, 86 (1983) 323. — 14. SURIRM, SCHAFF HV, DEARANI JA, SUNDT TM, DALY RC, MULLANY CJ,ENRIQUEZ-SARANO M, ORSZULAK TA, Ann Thorac Surg, 82 (2006)819. — 15. GASPAROVIC H, UNIC D, SUTLIC Z, HUSEDZINOVIC I,BIOCINA B, RUDEZ I, NIKIC N, JELIC I, Coll Antropol, 32(1) (2008)293. — 16. GASPAROVIC H, ZUPANCIC-SALEK S, BRIDA V, DULIC G,JELIC I, Coll Antropol, 31(1) (2007) 355. — 17. CORIC V, MILICIC D,GASPAROVIC H, RAJSMAN G, SIRIC F, JELIC I, Coll Antropol, 30(4)(2006) 909. — 18. BRKIC K, UNIC D, SUTLIC Z, BIOCINA B, RUDEZ I,BARIC D, LUKIC IK, Coll Antropol, 30(2) (2006) 395.I. MedvedDepartment of Cardiac Surgery, University Hospital Rijeka, Tome Stri`i}a 3, 51000 Rijeka, Croatiae-mail: igor.medved@ri.t-com.hrJE LI POPRAVAK MITRALNOG ZALISTKA SIGURAN ZAHVAT U STARIJIH OSOBA?S A @ E T A KCilj ove randomizirane prospektivne studije bio je procijeniti poslijeoperacijski mortalitet i morbiditet nakon po-pravka mitralnog zalistka, uspore|uju}i dvije kirur{ke tehnike lije~enja mitralne insuficijencije u starijih bolesnika.Uspore|ivao se popravak i zamjena mitralnog zalistka u bolesnika starijih od 70 godina. U razdoblju od 1. sije~nja 2007.do 30. kolovoza 2009., 80 pacijenata sa bolesti mitralnog zalistka, izoliranom ili udru`enom s ostalim komorbiditetima,predvi|eno je za popravak ili za zamjenu mitralnog zalistka u na{oj ustanovi. Bolesnici su randomizirani u dvije sku-pine (popravak ili zamjena) pomo}u omotnica s metodom slu~ajnih brojeva. Rezultati ne pokazuju razliku u poslije-operacijskom bolni~kom mortalitetu i morbiditetu. U skupini bolesnika podvrgnutih zamjeni mitralnog zalistka, imalismo jednu zna~ajnu komplikaciju u obliku rupture lijevog ventrikla uz nalaz zna~ajno kalcificiranog stra`njeg dijelaprstena mitralnog zalistka. U kona~nici, nismo na{li zna~ajnih razlika koje bi davale prednost jednoj od navedenihtehnika, s obzirom na bolni~ki mortaltet i morbiditet.I. Medved et al.: Mitral Valve Repair in Elderly, Coll. Antropol. 34 (2010) Suppl. 2: 213–215215

Is Mitral Valve Repair Safe Procedure in Elderly Patients?

Medved, Igor

Anić, Darko

Oštrić, Marin

Zrnić, Boris

Ivančić, Aldo

Tomulić, Vjekoslav

Repository of the University of Rijeka, Faculty of Medicine

HRČAK - Portal of Croatian Scientific and Professional Journals

Coll. Antropol. 34 (2010) Suppl. 2: 213–215Professional paperIs Mitral Valve Repair Safe Procedure in ElderlyPatients?Igor Medved1, Darko Ani}2, Marin O{tri}1, Boris Zrni}1, Aldo Ivan~i}3 and Vjekoslav Tomuli}41 Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia2 Department of Cardiac Surgery, University Hospital Zagreb, Zagreb, Croatia3 Department of Thoracic and Vascular Surgery, University Hospital Rijeka, Rijeka, Croatia4 Department of Cardiology, University Hospital Rijeka, Rijeka, CroatiaA B S T R A C TThe aim of this randomized, prospective, study was to evaluate postoperative hospital mortality and morbidity aftermitral valve repair by comparing two surgical techniques for resolving mitral valve insufficiency in elderly patients. Incomparison were: mitral valve repair vs. mitral valve replacement in patients older than 70 years. In period from Janu-ary 1st 2006 until August 30th 2009. Eighty patients with mitral valve disease, isolated or associated with other co mor-bidities, were scheduled for mitral valve repair or mitral valve replacement in our institution. Patients were randomizedin two groups, one scheduled for mitral valve repair and another one for mitral valve replacement using the envelopemethod with random numbers. Results show no difference in hospital mortality and morbidity postoperatively in bothgroups. In group undergoing valve replacement we had one significant complication of ventricle rupture in emphaticallycalcified posterior part of mitral valve annulus. In conclusion we found no distinction in postoperative hospital mortalityand morbidity after using one of two surgical techniques.Key words: mitral valve disease, repair; replacement, elderly patientsIntroductionIn last decade there is an increasing number of pa-tients older than 70 years scheduled for cardiac surgery1.Mitral valve (MV) repair is an established surgical me-thod for the treatment of mitral insufficiency (MI). MVrepair is more preferred over replacement in younger pa-tients, but in patients over 70 years it is still contro-versial2–4. MV surgery in older people requires greatskills and experience because of cardiac and non-cardiacco morbidities5–7. Older patients often are not scheduledfor MV repair because of co morbidities and perceptionthat they may not tolerate prolonged cardiopulmonarybypass in case of inadequate repair. Elderly patients, inpresumption, do not benefit from MV repair due to shortlife expectancy. Therefore, the objective of this study isfocused on postoperative hospital mortality and morbid-ity after MV repair in elderly.Patients and MethodsAfter obtaining approval from the Medical FacultyEthics Committee and consent from all the patients,eighty consecutive patients older than 70 years with MVinsufficiency were scheduled to undergo MV repair or re-placement from January 1st 2007 to June 30th 2009 in ourinstitution. Patients with previous MV surgical treat-ment, myocardial infarction within 7 days, and youngerthen 70 years were excluded from the study. Both groupswere randomized using the envelope method with randomnumbers. Demographic and clinical profiles of groups arepresented in Table 1. There were no significant differ-ences between two groups in age, sex, weight, height, comorbidities, and medications. General anesthesia (withthe application of propofol, midazolam, atracuronium,and inhaled isofluranum) was facilitated. Heparin wasadministrated in dosage of 3 mg/kg to achieve an acti-213Received for publication January 10, 2010vated clotting time (ACT) >480 sec. Protamine was usedto reverse the effect of heparin at the dose ratio of 1.5:1.Surgical techniqueSurgical access was through a full midline sternotomyon full cardiopulmonary bypass within all cases. Moder-ate systemic hypothermia was used. Anterograde Cala-fiore cardioplegia followed with retrograde cardioplegiawas delivered. MV approach was through the right in-teratrial grove atriotomy. All patients had MV insuffi-ciency grade III-IV. Etiology of MV insufficiency was dif-ferent (myxomatous, rheumatic, ischemic and as anresult of endocarditis). In case of MV insufficiency gradeII due to ischemic etiology, intraoperative dynamic test-ings were made (volume overload in combination withpressure-afterload test). In case of MV insufficiency pro-gresion we performed MV surgery.Statistical analysisData are presented as mean ± standard deviation. Thec2-test and Fisher Exact test were used to compare vari-ables. The nonparametric Mann-Whitney test was usedto calculate the difference between the two groups. Anal-ysis was performed with MedCalc Software (MedCalcInc., Mariakerke, Belgium). A value of p<0.05 was re-quired for significance.ResultsEighty patients were divided in two groups; 40 pa-tients undergoing MV repair and 40 patients undergoingMV replacement. Due to other cardiac pathology, ex-tended surgical procedures were made. Basic demogra-phic and preoperative values were not significantly dif-ferent between groups. Intraoperative ischemic time wassignificantly longer in MV repair group. Number andtype of concomitant procedures were not significantlydifferent between groups (Table 2). Postoperatively onlydifference was in prolonged ventilatory support in MVrepair group (Table 3).DiscussionIn this study we have evaluated postoperative hospi-tal mortality and morbidity after mitral valve surgery,comparing MV repair versus MV replacement in popula-tion older than 70 years. MV disease is an increasingmedical problem mainly due to an ageing population andtreatment of other cardiac diseases8–18. MV replacementis simple and relatively quick operation and has achievedpredictable and good long-term results. Reconstructionof MV, developed and popularized by Carpentier, becamea standard in degenerative mitral regurgitation or dilata-tion of mitral annulus11–14. Although MV repair is timeconsuming (106,75 min of ischemic time in repair groupversus 86,46 min in replacement group) especially in el-derly patients, the overall results are not different. Insome cases the implantation of artificial chordae had tobe added to MV repair to eliminate incompetence, whichwas also, the reason for prolonged ischemic time in re-pair group. We think that prolonged ventilatory supporttime can be associated with prolonged ischemic time.Both did not influence postoperative morbidity and mor-tality.I. Medved et al.: Mitral Valve Repair in Elderly, Coll. Antropol. 34 (2010) Suppl. 2: 213–215214TABLE 1BASELINE DEMOGRAPHIC CHARACTERISTICSVARIABLEMV REPAIRn=40MV REPLACEMENTn=40Age/years 76±5 74.3±3female 3 12smoking 1 1previous IM 4 3hypercholesterolemia 7 9hypertension 7 12ejection fraction 40% 45%Euro-score 16.94 % 15.76%pulmonary diseases 10 8TABLE 2INTRAOPERATIVE DATAVARIABLEMV REPAIRn=40MV REPLACEMENTn=40mean bypass time 130 min 120.06 minmean ischemic time 106.75 min 86.46 minconcomitant procedureCABG 7 10TV anuloplasty 15 12AV replacement 15 10Aortic surgery 2 1RF ablation 21 27TABLE 3POSTOPERATIVE DATAVARIABLEMV REPAIRn=40MV REPLACEMENTn=40myocardial infartion 2 1postoperative CK-Mb(IU/L)30 40bleeding (24 h) 720 mL 650 mLreoperation 0 1respiratory complica-tion5 4time of ventilatorysupport/days15 10.5neurologicdisfunction1 1ICU stay/days 5.2 4.2in-hospital stay/days 15 13.5in-hospital death 2 1After evaluating mitral regurgitation grade>II, usingtransoesophageal echocardiography in operating room,in 3 cases MV replacement was preformed following in-adequate repair.We had 3 in hospital deaths. In MV repair group onepatient died from perioperative myocardial infarction,and other from multiorgan failure. In replacement groupone patient died from rupture of ventricle in emphati-cally calcified posterior part of mitral valve annulus.In summary, there was no difference in any of twotechniques regarding hospital mortality and morbiditypostoperatively. According to our results we think thatMV repair is safe technique when feasible, even in el-derly patients. Experienced surgeon should perform MVrepair to minimize repair failure and prolong bypasstime.R E F E R E N C E S1. TSAI TP, MATLOFF JM, GRAY RJ, CHAUX A, KASS RM, LEEME, CZER LS, J Thorac Cardiovasc Surg, 91 (1986) 924. — 2. DETAINTD, SUNDT TM, NKOMO VT, SCOTT CG, TAJIK AJ, SCHAFF HV, ENRI-QUEZ-SARANO M, Circulation, 114 (2006) 265. — 3. JEBARA VA, DER-VANIAN P, ACAR C, GRARE P, MIHAILEANU S, CHAUVAUD S, FA-BIANI JN, DELOCHE A, CARPENTIER A, Circulation, 86 (1992) 53. —4. AILAWADI G, SWENSON BR, GIROTTI ME, GAZONI LM, PEELERBB, KERN JA, FEDORUK LM, KRON IL, Ann Thorac Surg, 86 (2008)77. — 5. NAGENDRAN J, NORRIS C, MAITLAND A, KOSHAL A, ROSSDB, Eur J Cardiothorac Surg, 28 (2005) 83. — 6. AZAR H, SZENTPE-TERY S, Eur J Cardiothorac Surg, 8 (1994) 298. — 7. SCOTT ML, STO-WE CL, NUNNALLY LC, SPECTOR SD, MOSELEY PW, SCHUMA-CHER PD, THOMPSON PA, Ann Thorac Surg, 48 (1989) 213. — 8.GILLINOV AM, WIERUP PN, BLACKSTONE EH, BISHAY ES,COSGROVE DM, WHITE J, LYTLE BW, MCCARTHY PM, J ThoracCardiovasc Surg, 122 (2001) 1125. — 9. GILLINOV AM, COSGROVEDM, BLACKSTONE EH, DIAZ R, ARNOLD JH, LYTLE BW, SMEDIRANG, SABIK JF, MCCARTHY PM, LOOP FD, J Thorac Cardiovasc Surg,116 (1998) 734. — 10. HICKEY MS, SMITH LR, MUHLBAIER LH, HAR-REL FE, REVES JG, HINOHARA T, CALIFF RM, PRYOR DB, RANKINJS, Circulation, 78 (1988) 51. — 11. BRAUNBERGER E, DELOCHE A,BERREBI A, ABDALLAH F, CELESTIN JA, MEIMOUN P, CHATEL-LIER G, CHAUVAUD S, FABIANI JN, CARPENTIER A, Circulation, 104(2001) 8. — 12. ENRIQUEZ-SARANO M, SCHAFF HV, ORSZULAK TA,TAJIK AJ, BAILEY KR, FRYE RL, Circulation, 91 (1995) 1022. — 13.CARPENTIER A, J Thorac Cardiovasc Surg, 86 (1983) 323. — 14. SURIRM, SCHAFF HV, DEARANI JA, SUNDT TM, DALY RC, MULLANY CJ,ENRIQUEZ-SARANO M, ORSZULAK TA, Ann Thorac Surg, 82 (2006)819. — 15. GASPAROVIC H, UNIC D, SUTLIC Z, HUSEDZINOVIC I,BIOCINA B, RUDEZ I, NIKIC N, JELIC I, Coll Antropol, 32(1) (2008)293. — 16. GASPAROVIC H, ZUPANCIC-SALEK S, BRIDA V, DULIC G,JELIC I, Coll Antropol, 31(1) (2007) 355. — 17. CORIC V, MILICIC D,GASPAROVIC H, RAJSMAN G, SIRIC F, JELIC I, Coll Antropol, 30(4)(2006) 909. — 18. BRKIC K, UNIC D, SUTLIC Z, BIOCINA B, RUDEZ I,BARIC D, LUKIC IK, Coll Antropol, 30(2) (2006) 395.I. MedvedDepartment of Cardiac Surgery, University Hospital Rijeka, Tome Stri`i}a 3, 51000 Rijeka, Croatiae-mail: igor.medved@ri.t-com.hrJE LI POPRAVAK MITRALNOG ZALISTKA SIGURAN ZAHVAT U STARIJIH OSOBA?S A @ E T A KCilj ove randomizirane prospektivne studije bio je procijeniti poslijeoperacijski mortalitet i morbiditet nakon po-pravka mitralnog zalistka, uspore|uju}i dvije kirur{ke tehnike lije~enja mitralne insuficijencije u starijih bolesnika.Uspore|ivao se popravak i zamjena mitralnog zalistka u bolesnika starijih od 70 godina. U razdoblju od 1. sije~nja 2007.do 30. kolovoza 2009., 80 pacijenata sa bolesti mitralnog zalistka, izoliranom ili udru`enom s ostalim komorbiditetima,predvi|eno je za popravak ili za zamjenu mitralnog zalistka u na{oj ustanovi. Bolesnici su randomizirani u dvije sku-pine (popravak ili zamjena) pomo}u omotnica s metodom slu~ajnih brojeva. Rezultati ne pokazuju razliku u poslije-operacijskom bolni~kom mortalitetu i morbiditetu. U skupini bolesnika podvrgnutih zamjeni mitralnog zalistka, imalismo jednu zna~ajnu komplikaciju u obliku rupture lijevog ventrikla uz nalaz zna~ajno kalcificiranog stra`njeg dijelaprstena mitralnog zalistka. U kona~nici, nismo na{li zna~ajnih razlika koje bi davale prednost jednoj od navedenihtehnika, s obzirom na bolni~ki mortaltet i morbiditet.I. Medved et al.: Mitral Valve Repair in Elderly, Coll. Antropol. 34 (2010) Suppl. 2: 213–215215

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Is Mitral Valve Repair Safe Procedure in Elderly Patients?

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