Mitral valve repair for mitral regurgitation--15 year results

Mitral valve repair (MVR) for mitral regurgitation (MR) has many advantages over mitral valve replacement. However, durability and reoperations after repair still remain major problems. The aim of our study was to analyze the outcome of MVR and to determine the significant risk factors for death and reoperations.

Methods: From June 1989 to June 2005, 259 patients underwent MVP for MR. The mean age was 57.5 years, 89 (34.3%) were female, in 82% the NYHA class was III or IV, in 43 (16.6%) the ejection fraction (EF) was low < 30% and 27 patients (10.4%) were operated on emergency. The causes of MR were ischemic in 128 (49.4%) patients, rheumatic disease in 60 (23.1%), degenerative in 66 (25.4%) and endocarditis in 5 (0.2%) patients. The valve pathology was annular dilatation in 142 (54.8%) patients, restricted leaflet motion in 120 (46.3%) and valve prolapse in 88 (33.9%) patients.

Results: There were 13 (5%) early and 15 (6%) late deaths in the whole group, with higher mortality for urgent operations--25.9%, for those with EF < 30%-11.6% and for ischemic patients--8.5%. Thirteen patients (5.2%) were reoperated from 1 to 62 months after the first operation. Most patients were in NYHA class I or II at follow-up. The results of the mitral reconstruction are excellent in 75.2% (MR? gr. I), good in 22.3% (MR < or = gr. II) and bad in 2.4% (MR - gr. II-III). Non-use of ring and Key's annuloplasty were identified as independent predictors for reoperation. The long-term survival at 15 years was 43.5% for ischemic patients and 75.6% for nonischemic patients.

Conclusions: Ischemic etiology of MR, low EF and urgent operations remains the main predictors for high operative mortality and suboptimal long-term survival. Severe perioperative TEE control and routine application of ring are crucial for improving the short and long-term results of mitral valve repair.