Mitral ValveRepair inRheumatic Disease TheFlexible Solution

Background. Mitral valve repair inrheumatic disease istechnically more difficult, andthere islittle information on thelong-term stability ofthis technique. Methods andResults. FromJanuary 1975 toDecember 1990, 327patients underwent mitral valve repair withtheDuranflexible ringannuloplasty forrheumatic valve disease. Meanage was 45.4± 12.6 years (range, 23to73years). Thetechniques usedforvalve repair include a Duranflexible ringannuloplasty inall cases,commissurotomy in272(83.2%), papillary muscle splitting in171(523%), andsubvalvular apparatus repair in59patients (18.0%o). Onehundred onepatients required associated tricuspid valve surgery(30.8%). Hospital mortality was 336%,being lower forpatients withisolated mitral valve repair (2.7%) thanthose withmitrotricuspid surgery(4.9%o). Meanfollow-up was 8.6 years(range, 1to17years) andwas 96.5%completed. Thirty-four patients required reoperation forseveremitral insufficiency in12, mitral restenosis in18,andaortic valve disease in4.Theactuarial curvefree fromreoperation formitral causeat16yearsis89.9±3.2%. Latemortality occurred in42patients (13.2%). Actuarial survival curve at16yearsis84.0±3.2% forisolated mitral valve repair and64.6±6.7% formitrotricuspid patients. Conclsions. Mitral valvereconstruction withDuranflexible ringannuloplasty inrheumatic valve disease entails a lowhospital mortality withsatisfactory long-term clinical results. (Circulation. 1993;88[part 11:1746-1753.)