The Puig-Massana-Shiley annuloplasty ring for mitral valve repair: experience in 126 patients.

Between October, 1982, and December, 1984, 126 patients at the Texas Heart Institute underwent mitral valve repair for mitral insufficiency utilizing the Puig-Massana-Shiley annuloplasty ring. Resection of a triangular-shaped wedge of the mural leaflet and direct suture repair was done in 42 patients, and anterior leaflet repair was used in 2 patients. There were 79 male (63%) and 47 female (37%) patients with a mean age of 58 years. Preoperatively, 95% were in New York Heart Association (NYHA) Functional Class III or IV. Concomitant cardiac operations were performed in 82 patients and included coronary artery bypass grafting (49%), aortic valve replacement (16%), repair of ventricular septal defect (2%), resection of left ventricular aneurysm (2%), and repair of atrial septal defect (1%). There were 8 early deaths (6.3%) and 11 late deaths (8.7%). In 44 patients undergoing mitral valve repair as an isolated primary procedure, operative mortality was 2.3%. Murmurs of mitral insufficiency were present in 5 patients postoperatively, but only 1 required early reoperation for mitral valve replacement. Follow-up data have been obtained on 80% of the patients. Postoperative Functional Class was obtained for 63 of the 82 surviving patients and showed 92% of these patients to be in NYHA Functional Class I or II. Mitral valve repair incorporating the Puig-Massana-Shiley annuloplasty ring and valve leaflet revision is a reliable technique that is not technically demanding. We believe these methods should be attempted for correction of pure mitral insufficiency, particularly in circumstances where other cardiac repairs are required.