Results of mitral valve reconstruction

COSGROVE, DELOS M M.D.
CHAVEZ, ALTAGRACIA M M.D.
LYTLE, BRUCE W M.D.
GILL, CARL C M.D.
STEWART, ROBERT W M.D.
TAYLOR, PAUL C M.D.
GOORMASTIC, MARLENE M.P.H.
BORSH, JUDITH A R.N.
LOOP, FLOYD D M.D.

Departments of Thoracic and Cardiovascular Surgery and Biostatistics, The Cleveland Clinic Foundation, Cleveland.

Address for correspondence: Delos M. Cosgrove, M.D., The Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave., Cleveland, OH 44106.

Received August 2, 1994; revision accepted September 23, 1994.

Circulation 74:p I82-I87, September 1986.

To evaluate the early results of mitral valve reconstruction for mitral insufficiency, 117 consecutive cases were analyzed. Sixty-four (57.7%) of the patients were men, and the mean age was 60 13 years (range 18 to 85). Eighty-nine (76%) of the patients were in NYHA functional class III or IV preoperatively. The cause of the mitral disease was degenerative in 94 (80%) and rheumatic in 13 (11%) patients. Isolated mitral valve repair was performed in 56 patients (47.9%); the remainder underwent associated procedures that included myocardial revascularization in 38 (32.5%). Ninetynine (85%) underwent a ring annuloplasty but in only seven (6%) was this the only repair technique. Resection of the posterior leaflet was performed in 41 (35%). There were five operative deaths (4.3%); one (1.8%) occurred after isolated repair and four (6.5%) after repair with associated procedures. All deaths occurred in patients greater than 65 years of age who were in NYHA functional class III or IV. Mean follow-up was 13.5 months (range 1 to 62). Two year actuarial survival was 90.6%. Three patients required reoperation (incidence of 2.5% per patient-year). Two patients sustained embolic events (incidence of 1.6% per patient-year). There were no anticoagulant-related complications. After surgery, 100 survivors (96.2%) were in NYHA functional class I or II.