DURABILITY OF MITRAL-VALVE REPAIR FOR DEGENERATIVE DISEASE

Background: Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the proced ure of choice. Objective: This study was undertaken to identify factor s influencing the durability of mitral valve repair. Patients and Meth ods: Between 1985 and 1997, 1072 patients underwent primary isolated m itral valve repair for valvular regurgitation caused bg degenerative d isease. Repair durability was assessed by multivariable risk factor an alysis of reoperation. It was supplemented by a search for valve-relat ed risk factors for death before reoperation. Three hospital deaths oc curred (0.3%); complete follow-up (4152 patient-years) was available i n 1062 of 1069 hospital survivors (99.3%). Results: At 10 years, freed om from reoperation was 93%. Among 30 patients who required reoperatio n for late mitral valve dysfunction? the repair failed in 16 (53%) as a result of progressive degenerative disease. Durability of repair was adversely affected by pathologic conditions other than posterior leaf let prolapse, use of chordal shortening, annuloplasty alone, and poste rior leaflet resection without annuloplasty. Durability was greatest a fter quadrangular resection and annuloplasty for posterior leaflet pro lapse and was enhanced by the use of intraoperative echocardiography, Death before reoperation was increased in patients having isolated ant erior leaflet prolapse or valvular calcification and by use of chordal shortening or annuloplasty alone. Conclusions: Repair durability is g reatest in patients with isolated posterior leaflet prolapse who have posterior leaflet resection and annuloplasty, Chordal shortening, annu loplasty alone, and leaflet resection without annuloplasty jeopardize late results.