Mitral Valve Repair. Results of The First Six Years

pp. 189-197

Abstract

Between January 1989 and January 1995, mitral valve repair was performed in 135 patients, either isolated or combined with other surgical procedures. Those patients in whom only commissurotomy with or without papillotomy was performed due to mitral stenosis are not included. Ages were between 1 and 78 years (mean 57±14) with a slight male predominance (69/66) . Ethiology was dysplasic 47%, rheumatic 31%, ischemic 13%, endocardial 7% and congenital 2% . Patients were divided into two groups: Group 1, 68 patients with only mitral surgery, and Group 2,67 patients in whom two or more procedures were combined (coronary revascularization, aortic valve replacement, aortic valve repair, correction of congenital disease and so forth) . Ninety seven percent had a "ringless" annuloplasty, mostly with autologous pericardium . Other techniques were added, such as leaflet resection, chord translocation, chord replacement, etc . In-hospital mortality was 4% in Group 1 and 12% in Group 2, averaging 8%. All patients were followed for a maximum of 72 months (mean 31.7 months ± 18 .9). At their last control 92% were in NYHA class I or II. Actuarial analysis showed that probabilities of no reoperation at 1, 3 and 5 years are 96%, 94% and 86% respectively; probability of survival at 1, 3 and 5 years is 91%, 89% and 89% respectively in Group 1, and 86%, 70% and 62% respectively in Group 2. No late endocarditis was found, and 4 patients (3%) had a stroke between the fourth and sixth years followup. Serial Echo-Doppler showed a significant reduction in ventricular diameters and a slight incidence of mitral regurgitation at follow-up.

Conclusions

Prosthetic rings for annuloplasty are not strictly necessary. Good immediate results persist at midterm. The influence of associated pathology at short and mid-term is significant .