SUPERIORITY OF MITRAL-VALVE REPAIR IN SURGERY FOR DEGENERATIVE MITRALREGURGITATION

Objectives We aimed to assess the influence of type of operation on ou tcome in degenerative mitral regurgitation. Methods We compared outcom es in 278 consecutive patients who underwent mitral valve repair (167 patients), replacement with subvalvular preservation (22 patients) and without subvalvular preservation (89 patients) for degenerative mitra l regurgitation. Results There was a trend towards lower mortality vii th repair and replacement with subvalvular preservation compared to re placement without subvalvular preservation. Thirty-day mortality was 1 .2% vs 0.0% vs 4.7% (ns) respectively. Six-year survival was, respecti vely, 67.8 +/- 7.4% (P=0.088) vs 80.8 +/- 11.0% (P=0.25) vs 63.3 +/- 5 .9% for all-cause death, 78.5 +/- 6.8% (P=0.063) vs 95.5 +/- 4.4% (P=0 .092) vs 67.6 +/- 5.9% for all complication-related death and 80.5 +/- 6.9% (P=0.076) vs 100.0 +/- 0.0% (P=0.045) vs 72.8 +/- 5.8% for compl ication-related death due to myocardial failure. Multivariate analysis confirmed independent beneficial effects from repair compared to repl acement without subvalvular preservation on complication-related death (hazard ratio 0.42, P=0.010) and death from myocardial failure (hazar d ratio 0.40, P=0.014), and from repair compared to mechanical replace ment on thromboembolism (hazard ratio 0.45, P=0.029) and anticoagulati on-related haemorrhage (hazard ratio 0.19, P=0.026). Conclusions Mitra l valve repair is superior to replacement. The greatest survival advan tage is in reduced mortality from myocardial failure. Repair should be the operation of choice for degenerative mitral regurgitation.