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Ann Thorac Surg 1993;56:7-14
© 1993 The Society of Thoracic Surgeons
Divisions of Cardiovascular Surgery and Cardiology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
* Address reprint requests to Dr David, 200 Elizabeth St, 13EN219, Toronto, Ont, Canada M5G 2C4.
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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M. S. Uva, G. Dreyfus, G. Rescigno, N. A. Aile, R. Mascagni, M. La Marra, F. Pouillart, S. Pargaonkar, E. Palsky, R. Raffoul, et al. SURGICAL TREATMENT OF ASYMPTOMATIC AND MILDLY SYMPTOMATIC MITRAL REGURGITATION J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1240 - 1249. [Abstract] [Full Text]
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E. M. Lee, L. M. Shapiro, and F. C. Wells Importance of Subvalvular Preservation and Early Operation in Mitral Valve Surgery Circulation, November 1, 1996; 94(9): 2117 - 2123. [Abstract] [Full Text]
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J. M. Alvarez, C. W. Deal, K. Loveridge, P. Brennan, R. Eisenberg, M. Ward, K. Bhattacharya, S. J. Atkinson, and C. Choong REPAIRING THE DEGENERATIVE MITRAL VALVE: TEN- TO FIFTEEN-YEAR FOLLOW-UP J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 238 - 247. [Abstract] [Full Text]
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N. G. Smedira, R. Selman, D. M. Cosgrove, P. M. McCarthy, B. W. Lytle, P. C. Taylor, C. Apperson-Hansen, R. W. Stewart, and F. D. Loop REPAIR OF ANTERIOR LEAFLET PROLAPSE: CHORDAL TRANSFER IS SUPERIOR TO CHORDAL SHORTENING J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 287 - 292. [Abstract] [Full Text]
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R. J. Cerfolio, T. A. Orszulak, J. R. Pluth, W. S. Harmsen, and H. V. Schaff REOPERATION AFTER VALVE REPAIR FOR MITRAL REGURGITATION: EARLY AND INTERMEDIATE RESULTS J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1177 - 1184. [Abstract] [Full Text]
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J. A. Odell, H. V. Schaff, and T. A. Orszulak Early Results of a Simplified Method of Mitral Valve Annuloplasty Circulation, November 1, 1995; 92(9): 150 - 154. [Abstract] [Full Text]
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M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, A. J. Tajik, K. R. Bailey, and R. L. Frye Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation : A Multivariate Analysis Circulation, February 15, 1995; 91(4): 1022 - 1028. [Abstract] [Full Text]
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T. Shimono, H. Yuasa, T. Mizumoto, K. Hatanaka, H. Kusagawa, and I. Yada New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidanceAn experimental study J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 719 - 726. [Abstract] [Full Text]
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C. W. Akins, A. D. Hilgenberg, M. J. Buckley, G. J. Vlahakes, D. F. Torchiana, W. M. Daggett, and W. G. Austen Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation Ann. Thorac. Surg., September 1, 1994; 58(3): 668 - 676. [Abstract] [PDF]
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L. H. Cohn, G. S. Couper, S. F. Aranki, R. J. Rizzo, N. M. Kinchla, and J. J. Collins Jr. Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 143 - 151. [Abstract] [Full Text]
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