113 Gene therapy with brca1 reduces systemic inflammatory response and multiple organ failure and improves survival in experimental sepsis

and echocardiographic follow-up. RESULTS: In-hospital mortality was 12%. One patient died in the operating room from atrioventricular groove rupture and 2 died from congestive heart failure postoperatively. During a mean follow-up of 51 31 months, 8 patients died. Of these, 3 were a result of cardiovascular causes. Four patients underwent reoperation because of failure of MV repair (2), endocarditis (1) or hemolysis (1). All survivors were NYHA 2, with none to trivial mitral regurgitation in all MV repairs (12). At 5 years, actuarial survival was 56 21%, freedom from cardiac death was 70 19% and freedom from MV reoperation was 82 16%. CONCLUSIONS: After aggressive decalcification of the posterior MV annulus both MV repair and replacement are feasible with acceptable procedure-related mortality. It is clear however, that decalcification increases complexity and risk. While an aggressive approach is advisable in young patients and those with infective endocarditis, the choice of a more conservative approach may be appropriate in fragile and elderly patients.