Mitral valve prolapse - Comparison between valvular repair and replacementin severe mitral regurgitation

Background; The aim of this study was to analyse long term results of mitra l valve repair of degenerative mitral regurgitation compared to valve repla cement. Methods. A hundred-twenty-five consecutive patients with severe mitral valv e insufficiency who underwent cardiac surgery from January 1987 to December 1995 were included in the study. Mean age was 55+/-16 years (77 males, 48 females). Mitral repair was performed in 62 patients and mitral valve was r eplaced in 63 patients. Mean follow-up was 5 years. The repair procedures w ere based on quadrangular resection of the posterior leaflet, chordal repla cement and transposition. Annuloplasty was performed in 100% of cases. The technique of valve replacement was conventional with complete excision of t he valve in the majority of cases. Results. Operative mortality following valve repair was 1.6%, no death occu rred in the prosthesic group. In the repair group overall survival and re-o peration rate were respectively 95.2% and 6.5%, while in the replacement gr oup were 93.7% and 7.9%. No endocarditis and thromboembolic accidents were observed following valvuloplasty, while in the prostheses 6.3% of patients had endocarditis and 1.6% had a thromboembolic event. Mild or moderate left ventricular dysfunction was present in 5 patients after valvuloplasty and in 9 patients with prostheses. Conclusions. Considering these results we conclude that, in patients with s evere degenerative mitral insufficiency, mitral valve repair is warranted w henever it is possible. The advantages given by maintaining the native valv e suggest that surgery should be considered in asymptomatic patients before the occurrence of the left ventricular dysfunction.