IMPROVED RESULTS WITH MITRAL-VALVE REPAIR USING NEW SURGICAL TECHNIQUES

From January 1987 to July 1994, 299 consecutive patients ranging from 4 to 80 years of age underwent mitral repair for pure valve insufficie ncy due to degenerative disease (59 %), rheumatic disease (23 %), endo carditis (12 %) or ischemic heart disease (6 %). During the initial pe riod, a variety of reparative methods were used following the principl es originally described by Carpentier. More recently, in our instituti on other surgical techniques have been introduced: specifically, prola pse of the anterior leaflet was corrected either by replacing the chor dae with polytetrafluoroethylene (PTFE) sutures or simply by anchoring the prolapsing free edge to the facing edge of the posterior leaflet (''edge-to-edge'' technique). Chordal transposition has also been used occasionally to correct the prolapse of the anterior leaflet. The hos pital mortality rate was 1.3 %. According to actuarial methods, the ov erall survival rate was 94 % at 7 years, and freedom from reoperation was 86 %. Significant incremental risk factors for reoperation were: n o use of prosthetic ring, correction of the prolapse of the anterior l eaflet by triangular resection or chordal shortening and ischemic etio logy of the mitral insufficiency (freedom from reoperation at 7 years was 61 %, 56 % and 51 %, respectively). In the late postoperative peri od (mean follow-up 3.6 years), 95 % of the patients were in NYHA class I or II; four patients had thromboembolic episodes, two hemorrhagic c omplications and two endocarditis. No patient in whom the prolapse of the anterior leaflet was corrected by the recently introduced techniqu e has required reoperation. The anterior mitral leaflet prolapse was t herefore neutralized as an incremental risk factor for reoperation and this has contributed to the improved overall results of mitral valve repair.