Mitral valve repair in a predominantly rheumatic population - Long-term results

Valve repair in rheumatic patients poses special problems due to valve defo rmity and mixed lesions. We present our experience from January 1988 throug h June 1999 in this retrospective study of 818 patients (377 males). The me an age was 22.8 +/- 11.3 years (range, 2 to 70 years). The cause of mitral regurgitation was rheumatic in 718 (88%) patients, congenital in 51, myxoma tous in 34, infective in 7, and ischemic in 8. Most patients (64%) were in New York Heart Association functional class III or IV. Congestive heart fai lure was present in 116 patients (14%). Reparative procedures included posterior collar annuloplasty (n=710). commi ssurotomy (n=482), cusp-level chordal shortening (n=237), cusp thinning (n= 222), cleft suture (n=166), and cusp excision/plication (n=42). Operative mortality was 4% (32 patients). Preoperative left ventricular dys function, presence of congestive heart failure, and advanced functional cla ss were associated with greater mortality. Follow-up ranged from 1 to 144 m onths (mean, 44.9 +/- 33.2 months) and was 96% complete. Most survivors (70 %) had no or trivial mitral regurgitation. Forty patients required reoperat ion for valve dysfunction. There were 23 (2.8%) late deaths. Actuarial, reo peration-free, and event-free survival at 17 years were 92.6% +/- 1.0%, 65. 0% +/- 10%, and 38% +/- 6.0%, respectively. Among the survivors, 85% were i n New York Heart Association functional class I. We conclude that mitral Valve repair in rheumatic patients, using current t echniques, can effectively correct hemodynamic and functional abnormalities with satisfactory results.