Conservative surgery of the mitral valve: a report of the first 100 cases from one unit and one surgeon

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Abstract
Objective—To report the first 100 mitral valve repairs performed in a unit with an aggressive approach to conservative mitral valve surgery. Design—Case notes were reviewed retrospectively and patients invited for clinical examination and cross sectional and Doppler echocardiography. Setting—Tertiary cardiothoracic referral centre. Patients—Between December 1985 and April 1991 mitral valve repair was carried out on 100 patients (66 males). Patients with pure mitral stenosis were excluded. Sixty seven had degenerative and 15 rheumatic mitral valve disease. Median age was 66 (range 12 to 79) years, with an interquartile range of 59 to 71 years. Interventions—Operative procedures included annuloplasty ring in 97, resection of the posterior leaflet in 67, resection of endocarditic portion of posterior leaflet in four, commissurotomy in six, and correction of anterior leaflet abnormalities in seven. Thirty nine concomitant cardiac procedures were performed in 32 patients. Six operations were emergencies, and three of these required concomitant procedures. Main outcome measures—Mortality, operative failure rate, patients' functional state and degree of residual mitral regurgitation, incidence of thromboembolism, and endocarditis. Results—Follow up ranged from one to 59 months, median 14 months, and an interquartile range of four to 23·5 months. Early mortality was 1%, late mortality 5%, and there was a 2% reoperation rate. Eighty four patients had moderate to severe mitral regurgitation preoperatively. At follow up mitral regurgitation was absent or mild in 78. Eighty six patients were in New York Heart Association (NYHA) class I–II at follow up compared with 80 in NYHA class III–IV preoperatively. There were no thromboembolic events. Conclusion—This study shows that satisfactory results can be obtained with mitral valve repair in a fairly elderly population with a high incidence of concomitant cardiac disorders. We suggest that these encouraging results will lead to earlier mitral valve repair in mitral regurgitation.