THE LONG-TERM RESULTS OF MITRAL-VALVE RECONSTRUCTION FOR THE FLOPPY VALVE

The myxomatous degenerated, prolapsed, or floppy mitral valve is the m ost common etiology of mitral regurgitation in North American populati ons. We performed mitral valve reconstruction for this diagnosis in 25 2 patients from 1984 to 1993. There were 165 males and 87 females rang ing in age from 23 to 84 years (mean 64 years); 93 (37%) were greater- than-or-equal-to 70 years. One hundred eighty-six were New York Heart Association Functional Class III or IV and 29% (72) underwent concomit ant coronary bypass operation. Operations included posterior leaflet r esection, anterior leaflet resection treatment of chordal pathology by shortening or Gore-Tex replacement, and ring annuloplasty. There were five operative deaths for an operative mortality of 2%. The operative risk in patients under 70 years was 1 of 159 (0.6%) and 4 of 93 (4%) in patients older than 70 years. Ninety percent of patients are asympt omatic in a follow-up period extending 10 years, while structural valv e degeneration requiring reoperation at 5 years was 85%. From 1990 to 1993 there has been a less than 5% absolute incidence of structural va lve degeneration. Mitral valve reconstruction for complicated floppy m itral valve is feasible and offers excellent early and medium-term res ults.