Mitral valve repair: a clinical and echocardiographic study

Abstract

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.