Mitral valve surgery: reconstruction versus replacement

The debate between reconstructive versus replacement operations for the diseased mitral valve has taken on new importance as the late results for survival, thromboembolic phenomena and incidence of reoperation from a variety of prosthetic and bioprosthetic cardiac valves have now become available. Three series of patients at the Brigham and Women's Hospital from 1972-84, representing 120 patients undergoing open mitral valve reconstruction for mitral stenosis, 348 patients undergoing mitral valve replacement for mitral stenosis, and 363 patients undergoing mitral valve replacement for mitral valve regurgitation are presented. The operative mortality in the reconstruction group was 0, there were 5 late deaths, all non-cardiac, 9 patients had a thromboembolism (1.8%/pt year), and 9 patients required reoperation (1.7%/pt year). For those who had mitral valve replacement for mitral stenosis the operative mortality was 10%, 6% for isolated replacement, 20% if this included a coronary artery bypass. At 9 years the long-term survival was 68 +/- 4%, freedom from thromboembolism 80 +/- 4%, and freedom from valve dysfunction 87 +/- 4%. In the replacement group for mitral regurgitation operative mortality was 11%, 20% with coronary artery bypass. Operative survival was 53 +/- 5% at 9 years, freedom from thromboembolism was 87 +/- 3%, and freedom from valve dysfunction was 91 +/- 4%.