EVALUATION OF THE LONG-TERM RESULTS OF MITRAL-VALVE REPAIR IN 254 YOUNG-PATIENTS WITH RHEUMATIC MITRAL REGURGITATION

Background Surgical valve repair for mitral regurgitation has signific ant advantages over valve replacement, but the durability of the techn ique varies according to the cause of mitral valve disease. In this st udy, we examined the long-term performance of this procedure in a youn g rheumatic population and also attempted to identify factors predicti ng a poor outcome. Methods and Results Between January 1981 and 1989, 308 patients underwent primary mitral valve repair for rheumatic mitra l regurgitation at our institution. Forty-nine patients who failed to report after surgery and another 5 with discordant data were excluded from the analysis. Mitral regurgitation was pure in 182 patients (72%) and associated with mild commissural fusion in 72 patients (28%). Pat ient ages ranged from 6 to 52 years (mean, 18+/-9 years). A total of 2 43 patients (96%) were in New York Heart Association class III or IV b efore surgery, and 66 (26%) had atrial fibrillation. Mean follow-up pe riod was 60+/-35 months (range, 1 to 132 months). Rheumatic activity w as present clinically in 30% and macroscopically during surgery in 32% . Surgical techniques included insertion of a Carpentier ring (99%), c hordal shortening (88%), leaflet resection (14%), chordal transpositio n (7%), and commissurotomy (28%). Operative mortality was 2.6%, late m ortality was 15%, and the reoperation rate was 27%. At 5 years, 96.8% of the patients were free from thromboembolism, 97.7% were free from e ndocarditis, 74.9% were free from reoperation, 66% were free from valv e failure, and 66.2% were free from major events. Multivariate analysi s identified active rheumatic carditis as a significant predictor of r eoperation, valve failure, and future events, while sinus rhythm and s horter bypass time at initial surgery were the only predictors of long -term survival. Patients with pure mitral regurgitation, sinus rhythm, and no active carditis at initial operation had the best overall 5-ye ar results. Among the 148 survivors without reoperation, 142 (96%) wer e in New York Heart Association class I and II, and 107 (72%) were in sinus rhythm. Doppler echocardiographic studies showed absence of mitr al regurgitation in 34 patients (23%), severe regurgitation in 23 (16% ), and severe mitral stenosis in 6 (4%). Conclusions Mitral valve repa ir in this young rheumatic population is associated with a high long-t erm morbidity. Presence of active rheumatic carditis has a significant ly adverse effect on the success of mitral valve repair.