Long-term (29 years) results of reconstructive surgery in rheumatic mitralvalve insufficiency

Background-Results of conservative surgery are well established in degenera tive mitral valve (MV) insufficiency. However, there are controversies in r heumatic disease. This study is the evaluation of one center for rheumatic MV insufficiency based on a functional approach. Methods and Results-From 1970 to 1994, 951 patients with rheumatic MV insuf ficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Aortic valve diseases were excluded. Mean age was 25.8 ye ars (4 to 75), and sinus rhythm was present in 63%. The functional classifi cation used was type I, normal leaflet motion., 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III. restricted leaflet mot ion, 345 patients (36%). The combined lesion of prolapse of the anterior le aflet and restriction of the posterior was present in 224 patients (24%). S urgical techniques used were implantation of a prosthetic ring in 95%, shor tening of the chords and leaflet enlargement with autologous pericardium, a nd commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 1 2 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89 +/- 19% at 10 years and 82 +/- 18% at 20 years. The rate of thromboembo lic events was 0.4% patients per year (33 events), with 3 deaths. Freedom f rom reoperation was 82 +/- 19% at 10 years and 55 +/- 25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The act uarial rate of reoperation was 2% patients per year and was correlated to t he degree of preoperative fibrosis. Conclusions-Conservative surgery of rheumatic MV insufficiency has a low ho spital mortality rate and an acceptable rate of reoperation. The results ar e excellent regarding the minimal risk of thromboembolic events.