Valve repair versus replacement in the surgical management of ruptured chordae. A post-operative echocardiographic assessment of mitral valve function

Abstract

Between January 1971 and December 1978, 74 patients (pts) underwent surgery for ruptured chordae (RC) of the mitral valve. Thirty-eight patients underwent mitral valve replacement and 36 patients underwent repair. The hospital mortality was 8.3% after repair and 7.9% after replacement. Repair was performed by trapezoidal excision of redundant leaflet, re-approximation of the leaflet edges and annuloplasty. At six years the incidence of re-operation after repair was 3% (1/33) and after mitral valve replacement was 14.7% (5/35). The five years survival was 68 +/- 8% after mitral valve replacement and 100% after repair. The incidence of major thrombo-embolic episodes was 0.67 per 100 patient years, without anticoagulation, after repair and 5.7 per 100 patient years, with anticoagulation, following mitral valve replacement. The peak rate of dimension change (PRDC) of the transverse dimension of the left ventricle was determined by echocardiography in 17 patients after repair. The PRDC was within normal range (10/20 cms/sec) in 15 patients, in the stenotic range (10 cms/sec) in 1 patient, and in the regurgitant range (20 cms/sec) in 1 patient. Mitral valve replacement invariably produces PRDC values in the stenotic range. Valve repair is the procedure of choice in ruptured chordae of the posterior leaflet.