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Mitral valve repair: a valuable procedure with good long term results even when performed infrequently
G J Cooper1, E M Wright, G H Smith
1Department of Cardiac Surgery, Northern General Hospital, Sheffield.
Objective:
To assess the results of mitral valve repair in a series with a low frequency of repair despite a policy to conserve the valve whenever possible.
Design:
Retrospective review of case notes with clinical and echocardiographic examination of survivors.
Setting:
Cardiac surgery unit in a university teaching hospital.
Patients:
62 consecutive patients undergoing mitral valve repair by one surgeon between 1979 and 1989.
Interventions:
Mitral valve repair according to the criteria and techniques of Carpentier.
Main Outcome Measures:
Frequency of repair, operative mortality, actuarial survival, freedom from reoperation and thromboembolism, clinical state, and echocardiographic state.
Results:
The 62 patients, median age 58 years (interquartile range 51 to 64 years), represent 14% (70% confidence interval 12% to 15%) of the 454 mitral valve operations performed in the study period. Operative mortality was 8% (70% CI 5% to 13%). Actuarial survival was 62% (70% CI 43% to 81%) at nine years. At nine years actuarial freedom from reoperation was 91% (70% CI 79% to 102%) and freedom from thromboembolism 91% (70% CI 80% to 102%). At a median follow up of 33 months (interquartile range 21 to 74 months), 38 of 46 survivors had improved functional state. Of 21 patients who underwent echocardiography one had severe mitral regurgitation and one mitral stenosis.
Conclusion:
Although compared with other reports of mitral valve repair the prevalence of repair was low in this series the results are comparable and justify a positive approach to repair in all patients undergoing mitral valve surgery even if this can only be achieved in a small proportion of patients.