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Results of mitral valve repair in rheumatic mitral regurgitation

^a Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110 029, India
^b Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
^c Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

*Corresponding author. Tel./fax: +91-11-26588889.

E-mail address: asampath_kumar{at}hotmail.com (A.Sampath Kumar).

Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4±10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (n=270, 30%), annular dilatation (n=717, 79.8%) and calcification (n=39, 4.3%). Reparative procedures included annuloplasty (n=793, 88%), commissurotomy (n=530, 59%), chordal shortening (n=225, 25%), cusp excision/plication (n=41, 4.5%), cuspal thinning (n=325, 36%), cleft suture (n=142, 16%), decalcification (n=30, 3.3%), chordal transfer (n=13, 1.4%), and neo chordae construction (n=3, 0.3%). Early mortality was 32 (3.6%). Follow-up ranged from 6 to 180 months (mean 62.7±31.8 months) and was 96% complete. Six hundred and twenty-one patients (69%) had no, or trivial, or mild MV. Two hundred and seventy-seven of the 866 survivors had MR which was moderate in 153 (18%) and severe in 124 (14%) patients. Thirty-five patients underwent re-operation. There were 21 late deaths (2.4%). Actuarial and re-operation-free survival at 10 years were 92±1.1% and 81±5.2%, respectively. Freedom from moderate or severe MR was 32±3.9%. MV repair in the rheumatic population is feasible with acceptable long-term results.

Key Words: Mitral valve repair; Rheumatic heart disease; Regurgitation

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