[Reconstructive surgery of the mitral valve. Experience with 400 cases]

From january 1980 to december 1992 a total of 400 valvulopathies were subjected to conservative mitral procedures: 364 had rheumatic heart disease, 33 were congenital abnormalities and 3 probably myxomatous. Functional class and the cardiomegaly, were in grade III and IV in most cases. Different procedures were done; the most common one was commisurotomy, also subvalvular apparatus opening, annuloplasty ring and a newly designed procedure called "Tension Stitch". The results were satisfactory, with a reoperation rate of 9.2%, mostly caused by fibrosis which in turn caused dysfunction. A second cause were technical problems. The mortality rate was 2%, and was not caused by the procedure itself but because of bad clinical status of the patients. The follow up period was 13 years and showed an actuarial survival curve of 98%, with 90.8% free of reoperation and a very good post-op quality of life. We present this analysis in a effort to bring this procedure to the attention of cardiac surgeons, considering it as an alternative to prosthesis placement.