Original article
Late results of mitral valve repair for mitral regurgitation due to degenerative disease

https://doi.org/10.1016/0003-4975(93)90396-YGet rights and content

Abstract

From June 1981 to August 1992, 184 patients with mitral regurgitation due to degenerative disease underwent mitral valve repair. The mean age was 57 years, and 74% were men. One-third of the patients were in atrial fibrillation, and 71% were in New York Heart Association classes III and IV. The mitral regurgitation was due to prolapse of the posterior leaflet in 97 patients (53%), prolapse of the anterior leaflet in 42 (23%), and prolapse of both leaflets in 45 (24%). The degree of myxomatous changes was assessed intraoperatively as mild in 125 patients (68%), moderate in 27 (15%), and severe in 32 (17%). Mitral valve repair was accomplished largely by techniques described by Carpentier. Ring annuloplasty was performed in 160 patients (66 with Carpentier ring and 94 with Duran ring). There was one operative death, and 5 patients experienced life-threatening complications. Patients were followed up from 5 to 132 months (mean, 41 months). The actuarial survival at 8 years was 88% ± 4%. The freedom from stroke at 8 years was 94% ± 2%, and the freedom from transient ischemic attacks was 86% ± 6%. Age greater than 60 years was the only factor associated with higher risk of thromboembolic complications by logistic regression analysis. The actuarial freedom from reoperation at 8 years was 95% ± 2%. Advanced myxomatous changes in the leaflets of the mitral valve was the only significant factor associated with a higher risk of reoperation. Most patients were in New York Heart Association class I at the last follow-up. Late postoperative Doppler echocardiography revealed satisfactory mitral valve function in 96% of the patients. Mitral valve repair for mitral regurgitation due to degenerative disease provides excellent long-term results except in patients with advanced myxomatous changes in both leaflets, in whom there is a higher risk of recurrent mitral regurgitation and reoperation.

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Cited by (216)

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    Our findings indicate that both groups had similar in-hospital mortality and morbidities and similar late survival, need for reoperation, and recurrent MR. Repairs of anterior leaflet and bileaflet prolapse have traditionally been considered to be more challenging and less durable than repair of posterior prolapse.1-4 Several techniques have been proposed to improve the outcomes of complex mitral prolapse including the creation of artificial chordae.10,11

  • Atrial Fibrillation and Mitral Valve Prolapse: Time to Intervene?

    2019, Journal of the American College of Cardiology
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Presented at the Twenty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1993.

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