Mitral valve repair: a clinical and echocardiographic study.

OBJECTIVE

To evaluate the clinical and echocardiographic results of mitral valve repair done within an 11 year period.

DESIGN

Retrospective review of case notes and clinical and echocardiographic examination of survivors. Analysis was made according to the intention to treat principle.

PATIENTS: A consecutive series of 94 patients with mitral valve disease who had mitral reconstruction between 1980 and 1991.

INTERVENTIONS: Mitral repair according to the techniques of Carpentier or Duran.

MAIN OUTCOME MEASURES: Operative mortality, actuarial survival, rates of freedom from reoperation, thromboembolism, infective endocarditis, clinical state, and echocardiographic findings.

RESULTS

There were equal numbers of males and females (mean (range) age 49 (4-74) years). The aetiology of mitral disease was degenerative in 59% and rheumatic in 30% of the patients. Operative mortality was 3%. The 10 year actuarial and valve related survival rates were 67% and 75%. At 10 years, 84% of the patients were free from thromboembolism, 94% free from haemorrhage related to anticoagulation, 88% free from infective endocarditis, and 73% free from reoperation. Of 75 survivors with completed follow up, 96% were in New York Heart Association functional class I or II and 64% were in sinus rhythm. Of 55 survivors who had an echocardiogram at follow up, normal left ventricular end diastolic dimension was shown in 76% and normal left ventricular shortening fraction in 89%. Doppler studies showed no mitral regurgitation in 36%, trivial or mild in 42%, moderate in 14%, and severe in 7% of patients. In stepwise logistic analysis previous myocardial infarction was associated with poor outcome (odds ratio: 13.7, p < 0.05).

CONCLUSION

The results are comparable with similar studies and support the value of mitral valve repair. There is reservation about the use of repair for patients with previous myocardial infarction.