MITRAL-VALVE RECONSTRUCTION VERSUS REPLACEMENT FOR DEGENERATIVE OR ISCHEMIC MITRAL REGURGITATION

Between January 1985 and June 1992, 263 consecutive patients had mitra l valve reconstruction (133 patients) or replacement (130 patients) fo r degenerative or ischemic mitral regurgitation. The two groups were s imilar in sex, age, prior infarctions or cardiac operations, hypertens ion, angina, and functional class. Both groups were similar in mean ej ection fraction, pulmonary artery pressure, cardiac index, and inciden ce of coronary artery disease. More reconstruction than replacement pa tients had ischemic etiology (22 [16%] versus 12 [9%]; p = not signifi cant), and fewer reconstruction patients had ruptured anterior leaflet chordae (9 [7%] versus 39 [30%]; p < 0.01). More reconstruction than replacement patients had concomitant cardiac procedures (67 [50%] vers us 59 [45%]; p = not significant). Hospital death occurred in 4 recons truction patients (3%) and 15 (12%) replacement patients (p < 0.01). M edian postoperative stay was shorter in reconstruction patients (10 ve rsus 12 days; p = 0.02). Late valve-related death occurred in 3 recons truction patients (2%) and 8 (6%) replacement patients (p = 0.08). Six -year actuarial freedom from thromboembolism was 92% for the reconstru ction group and 85% for the replacement group (p = 0.12). Freedom from all valve-related morbidity and mortality was 85% for the reconstruct ion patients and 73% for the replacement patients (p = 0.03). Signific ant multivariate predictors of hospital death were age, mitral valve r eplacement, functional class, congestive heart failure, no posterior c hordal rupture, and nonelective operation. Mitral valve reconstruction , when technically feasible, is the procedure of choice for degenerati ve or ischemic mitral regurgitation because of significantly lower hos pital mortality and late valve-related events.