Reconstructive surgery of pure mitral insufficiency. Operative results and follow-up in 128 patients

Short and long-term results of valve repair for pure mitral insufficiency are reported in 128 consecutive patients with a mean age of 49 years (range 4-75). The etiology of the mitral valve dysfunction was degenerative in 54% of the cases, rheumatic in 30%, ischemic in 9.5%, endocarditic in 6.5%. Preoperatively, 91% of the patients were in NYHA class II or III. The anatomic lesions and the mechanism of mitral regurgitation were identified preoperatively by transthoracic and/or transesophageal echocardiography. Cardiac catheterization was performed only in patients with multiple valvular dysfunction and/or with evidence of concomitant coronary artery disease. Mitral repair was performed according to the techniques proposed by Carpentier. Only one patient died in the hospital (operative mortality: 0.8%). By actuarial methods, 96% of the patients were alive 4 years postoperatively, and 84% were reoperation free. Freedom from reoperation was significantly higher in patients who received a prosthetic ring than in those who had other types of anuloplasty (96% vs 67%; p < 0.05). During the follow-up period no patient had thromboembolic episodes. Ninety-seven per cent of the 112 patients who survived the operation and were not reoperated were in NYHA class I or II. These results confirm the validity of reconstructive surgery in pure mitral insufficiency. The use of a prosthetic ring gives stability to the repair and improves long-term results.