Reconstructive surgery for acquired valve disease

There has been a continuing controversy between reconstructive valve surgery and replacement. In this paper, an analysis of clinical and hemodynamic late results of the patients undergoing open mitral commissurotomy (OMC, 135 patients), repair of mitral regurgitation (MAP, 32 patients), and combined valvuloplasty (62 patients) was presented. 1) OMC: The 10-year actuarial survival rate was 86.5% postoperatively. None of the patients required reoperation in this series. Clinical and hemodynamic improvements mainly depended upon the anatomical severity of a stenosed mitral valve. 2) MAP: The 10-year actuarial survival rate was 94% postoperatively. Especially, good to excellent results were obtained in the patients with mitral regurgitation due to ruptured chordae or dilated annulus. 3) Combined valvuloplasty: The 10-year actuarial survival rates postoperatively were 90% in OMC + tricuspid annuloplasty group (31 patients), 100% in MAP + tricuspid annuloplasty group (7 patients), and 87.2% in OMC + aortic commissurotomy group (24 patients). The reconstructive valve surgery provides very small operative risk, very low late mortality and morbidity. Therefore, it should be the treatment of choice for most of the patients with symptomatic valve disease.