MITRAL-VALVE REPAIR IN RHEUMATIC DISEASE - THE FLEXIBLE SOLUTION

Background. Mitral valve repair in rheumatic disease is technically mo re difficult, and there is little information on the long-term stabili ty of this technique. Methods and Results. From January 1975 to Decemb er 1990, 327 patients underwent mitral valve repair with the Duran fle xible ring annuloplasty for rheumatic valve disease. Mean age was 45.4 +/-12.6 years (range, 23 to 73 years). The techniques used for valve r epair include a Duran flexible ring annuloplasty in all cases, commiss urotomy in 272 (83.2%), papillary muscle splitting in 171 (52.3%), and subvalvular apparatus repair in 59 patients (18.0%). One hundred one patients required associated tricuspid valve surgery (30.8%). Hospital mortality was 3.36%, being lower for patients with isolated mitral va lve repair (2.7%) than those with mitrotricuspid surgery (4.9%). Mean follow-up was 8.6 years (range, 1 to 17 years) and was 96.5% completed . Thirty-four patients required reoperation for severe mitral insuffic iency in 12, mitral restenosis in 18, and aortic valve disease in 4. T he actuarial curve free from reoperation for mitral cause at 16 years is 89.9+/-3.2%. Late mortality occurred in 42 patients (13.2%). Actuar ial survival curve at 16 years is 84.0+/-3.2% for isolated mitral valv e repair and 64.6+/-6.7% for mitrotricuspid patients. Conclusions. Mit ral valve reconstruction with Duran flexible ring annuloplasty in rheu matic valve disease entails a low hospital mortality with satisfactory long-term clinical results.