Mitral valve repair in rheumatic patients

BACKGROUND: There is controversy regarding the role of reparative technique s for rheumatic-mitral valve disease. We have analyzed the late results of mitral valve repair in a group of patients with rheumatic mitral valve insu fficiency. METHODS: From March 1980 to December 1997, 201 patients with rheumatic feve r underwent mitral valve repair at the Heart Institute, Hospital das Clinic as, Medical School, University of Sao Paulo. The mean age of patients was 2 6.9 +/- 15.4 years, with 59.7% of the patients being female. Other diagnose s were present in 67.7% of patients; the most common was tricuspid regurgit ation (31.3%). Mitral valve repair techniques included: 1) Carpentier ring annuloplasty in 75 patients (37.3%); 2) posterior annuloplasty with bovine patch in 68 patients (33.8%); 3) posterior segmental annuloplasty in 16 pat ients (7.9%); 4) quadrangular resection of the posterior leaflet with ring plication in 11 patients (5.5%); 5) partial resection of the anterior leafl et in 6 patients (3%); 6) De Vega's annuloplasty in 6 patients (3%); 7) Kay 's annuloplasty in 5 patients (2.5%); 8) Reed's annuloplasty in 4 patients (2%); and 9) miscellaneous techniques in 10 patients (4.9%). Combined techn iques were used in 94 patients (46.8%), the most frequent of which was chor dal shortening (48 patients, 23.9%). Other non-mitral cardiac procedures we re performed in 113 patients (56.2%). Actuarial survival and event-free cur ves (Kaplan-Meier method) were compared by linear regression analysis. RESULTS: The in-hospital mortality rate was 2.0% (four patients). The cause s of death were multiorgan failure in two patients and low cardiac output i n the other two patients. In the late postoperative period, 83.9% of the pa tients were in New York Heart Association (NYHA) functional class 1. The ac tuarial survival was 93.9% +/- 1.9% at a mean of 125 months. Twenty-three p atients were reoperated in the postoperative period at a mean interval of 3 5.7 months. Survival free from reoperation was 43.3% +/- 13.7% at 125 month s. When analyzing the patients according to age, actuarial survival was 91. 3% +/- 3.8% in the group of patients younger than 16 years (Group 1), compa red with 95.6% +/- 2.7% in the group older than 16 years (Group 2), with a statistically significant difference of p < 0.0001. Survival free from reop eration was 50.8% +/- 16.9% in Group 1 and 47.0% +/- 14.9% in Group 2 (p < 0.0001). CONCLUSIONS: Late results obtained with mitral valve repair for rheumatic m itral valve insufficiency were satisfactory and exceeded those reported for mitral valve replacement in the same population.