The Outcomes of Intraoperative Transesophageal Echocardiography-Guided Mitral Valvuloplasty

Objective: To analyze the result of mitral valve repair after intraoperative transesophageal echocardiography (TEE), performed by certified individuals, being used as a routine standard intraoperative monitoring. Material and Method: A single center, retrospective chart review combined with prospective cohort study of 325 consecutive patients undergoing mitral valve repair from March 2009 to November 2013 was conducted. Survival rate, mitral regurgitation (MR) recurrence and other adverse events were collected and analyzed. Results: There were a total of 266 patients with complete data included in the study. Early perioperative mortality was 2.6% (7 deaths, 0 to 30^th postoperative day) and late mortality was 3.8%. The MR recurrence was 3.9% per year. Annular dilatation (53%), prolapsed (36.8%) and flail (19.6%) posterior mitral valve leaflet were the 3 most common causes of MR. The most frequently employed surgical techniques were ring annuloplasty in 250 (94%) patients and quadrangular resection in 57 (21.4%) patients. Kaplan-Meier analysis demonstrated freedom from death and recurrent MR were 89.7% at 1 year, 86.9% at 2 year, and 81.4% at 4 years after the procedure. Univariate analysis identified the chordal transfer technique a risk factor for MR recurrence (RR 8.976, 95% CI 1.64 to 32.67, p>0.01). Conclusion: The outcome of mitral valve repair at our institution in the era of standard TEE guidance is favorable. The chordal transfer repair technique was identified as a risk factor for MR recurrence.