Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency

Background-Mitral valve repair is considered the gold standard in surgery o f degenerative mitral valve insufficiency (MVI), but the long-term results (> 20 years) are unknown. Methods and Results-We reviewed the first 162 consecutive patients who unde rwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacte rial endocarditis in 16 patients (10%). MVI was isolated or. in 18 cases. a ssociated with tricuspid insufficiency. The mean age of the 162 patients (1 04 men and 58 women) was 56 +/- 10 years (age range 22 to 77 years). New Yo rk Heart Association functional class was I, II, III, and IV in 2%. 39%, 52 %, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58 +/-0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier's fu nctional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier's ri ng annuloplasty in all cases, a valve resection in 126 patients, and shorte ning or transposition of chordae in 49 patients. During the first postopera tive month. there were 3 deaths (1.9%) and 3 reoperations (2 valve replacem ents and I repeat repair [ 1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a med ian of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kapl an-Meier survival rate was 48% (95% CI 40% to 57%). which is similar to the survival rate for a normal population with the same age structure. The 20- year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardia c cause, stroke, and reoperation). During the 20 years of follow-up, 7 pati ents were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the ini tial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study. 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except I were in New York Heart Association functional class I/II. Conclusions-Mitral valve repair using Carpentier's technique in patients wi th nonrheumatic MVI provides excellent long-term results with a mortality r ate similar to that of the general population and a very low incidence of r eoperation.