Mitral valve annuloplasty: results in an underdeveloped population

The long term results of mitral valve annuloplasty for pure mitral regurgitation are assessed. Thirty-three of the 100 patients (mean age 16 years) had acute rheumatic carditis at the time of operation. Three basic techniques were used: measured asymmetrical annuloplasty (Reed) in 37 patients, posterior plication annuloplasty in 56, Carpentier ring in seven. There were six early deaths, two of which were valve related. The mean follow up period for surviving patients was 4.8 (SD 1.2) years (range 3-9 years). Fourteen patients died late, all but one from valve related causes. Twenty-five had reoperation and all these had mitral valve replacement. The actuarial survival with initial repair was 56% at five years and 42% at eight years. Thirteen patients were lost to follow up. Of the remaining 42 patients, only 27 have an excellent or good clinical result. Eleven patients have only a satisfactory result, with a significant degree of residual or recurrent mitral regurgitation or disability or both. Possible causes of valve related failure were investigated; no significant difference was found between age groups or between acute and chronic cases. Poorer results, of statistical significance, were observed in patients in functional class IV and in those whose operation was performed on an emergency basis. No difference could be found between the results of the three techniques of mitral valve annuloplasty used. This retrospective study indicates that conservative procedures which are limited to annular repair produce inferior results. Valvuloplasty has many theoretical advantages which need practical confirmation.