LONG-TERM OUTCOME OF MITRAL-VALVE REPAIR OF DYSTROPHIC MITRAL REGURGITATION

Between January 1984 and December 1994, 130 patients underwent mitral valvuloplasty for pure dystrophic mitral regurgitation. There were 94 men and 36 women with a mean age of 61 +/- 9 years : 52 patients were in atrial fibrillation : 91% of patients were in NYHA Classes III or I V. At preoperative echocardiography, the regurgitation was assessed as Grade III or IV and classified using the Carpentier classification ac cording to type I (dilatation of the annulus) or II (mitral valve prol apse) : 95% of patients had isolated prolapse of the posterior leaflet , 3% had isolated prolapse of the anterior leaflet and 2% had prolapse of the two leaflets. After valvuloplasty, a prosthetic ring was impla nted in 124 patients (95%). The early mortality was 3% ; 5.3% of patie nts had early complications. All patients underwent control transthora cic echocardiography in the first postoperative week. They were review ed with a second transthoracic echocardiography after a mean follow-up of 5 +/- 0.3 years and a cumulative follow-up of 657 years-patients. At the immediate postoperative echocardiography, 24 minimal residual r egurgitations were observed ; at long-term, 20 new mitral regurgitatio ns developed, all mild without any clinical symptoms and 98% of patien ts were in the NYHA Classes I or II. At 10 years, the actuarial surviv al was 73 +/- 16%; absence of thromboembolic complications 95 +/- 3%, absence of reoperation 95 +/- 5%. This study confirms the efficacy of mitral valvuloplasty and the postoperative stability of repaired valvu lar lesions. These results suggest that the operative indications shou ld be considered at an earlier stage.