LONG-TERM RESULTS OF MITRAL-VALVE RECONSTRUCTION FOR REGURGITATION OFTHE MYXOMATOUS MITRAL-VALVE

The myxomatous, degenerated, prolapsed or ''floppy'' mitral valve is t he most common cause of mitral regurgitation in North America. Mitral valve reconstruction for mitral regurgitation was carried out in 219 c onsecutive patients with a myxomatous mitral valve from 1984 to 1993. Of the 139 men and 80 women, 23 to 84 years of age (mean 63 years), 36 % of patients were 70 years of age or older, 77% were in New York Hear t Association functional class III or IV, and 29% had coronary artery disease necessitating coronary bypass. The most common operation was p osterior leaflet resection (161 patients [73%]). The anterior leaflet was resected in 14 patients, and both the anterior and posterior leafl ets were resected in 15 patients. A variety of other techniques were u sed, including commissuroplasty and use of annuloplasty rings. A flexi ble Duran ring was used in 111 patients (51%), a Carpentier-Edwards ri ng in 44 patients (20%), and no ring was used in 64 patients (29%). Fi ve operative deaths occurred (2.3%); four of the five deaths occurred in patients 70 years of age or older (5.1%); and one in 141 patients ( 0.7%) was younger than 70 years of age. in the late postoperative peri od (mean follow-up 2 years), 90% of patients had no symptoms, two had endocarditis, and seven patients had thromboemboli; (transient in four , permanent in three). Structural valve degeneration requiring reopera tion occurred late in 12 patients; eight were in posterior. leaflet re section and two in anterior oi, anterior and posterior; six of 12 had no annuloplasty ring. The incidence of structural valve degeneration w as less than 5% from 1990 to 1993. No systolic anterior motion of the mitral valve was seen with postoperative echocardiography before disch arge. Actuarial analysis at 5 years for overall survival was 86% +/- 5 %, freedom from infectious valve degeneration 97% +/- 2%, and freedom from thromboembolism 94% +/- 3%. Freedom from structural valve degener ation overall was 83% +/- 4%, with a flexible ring it was 89% +/- 6%, with a rigid ring it was 88% +/- 6%, and with no ring it was 67% +/- 1 2% (p = 0.03). Mitral valve reconstruction for complicated myxomatous disease of the mitral valve, regardless of leaflet involvement, is fea sible and offers excellent early and late results.