Repairing the degenerative mitral valve: ten- to fifteen-year follow-up

From January 1969 to December 1992, mitral valve reconstructive operations were performed on 155 patients with degenerative mitral valve disease. There were 102 male and 53 female patients, with a mean age of 60.5 +/- 9.2 years, a mean duration of symptoms of 3.8 +/- 2.7 years, and 34% were in atrial fibrillation. All patients were in New York Heart Association functional classes III and IV before operation. The degree of mitral regurgitation was severe in 94% and moderate in 6%, and 50.9% of patients had moderate to severe impairment of left ventricular function. Emergency operation was undertaken in 7.1% of cases; 19% of patients underwent additional procedures. All patients had posterior mitral leaflet pathology and 19 patients had anterior mitral leaflet pathology. Ring annuloplasty was used in only 3% of cases. The operative mortality rate was 3.9%, 9% of patients had morbid events, and 4.5% of patients had repair failure within 6 months. All patients have been followed up with serial echocardiography for a mean time of 5.2 +/- 0.3 years (range 0.5 to 24 years). Immediately after operation, 92.9% had no mitral regurgitation to mild mitral regurgitation. At last follow-up, 96.9% had no mitral regurgitation to mild mitral regurgitation by echocardiography and 98% of patients were in New York Heart Association functional classes I and II. The actuarial survival at 15 years was 46% +/- 11%, freedom from reoperation was 84.9% +/- 11%, freedom from infective endocarditis was 96.0% +/- 11%, freedom from thromboembolism was 90.4% +/- 11%, and freedom from all valve-related events was 36.7% +/- 11%. It is well documented that repair of degenerative mitral valves offers excellent short-term and medium long-term benefits. This series represents the longest follow-up reported outside Europe. Our results beyond 10 years support our conclusion that an annuloplasty ring is not an absolute prerequisite for achieving successful repair of proven durability in most patients with degenerative mitral valve disease.