952-25 Carpentier Techniques for Mitral Valve Reconstruction: Experiences in 560 Patients Over 14 Years

Abstract

Between 6/79 and 6/93 a total of 560 patients with mitral insufficiency had Carpentier type mitral valve reconstruction with ring annuloplasty. The primary etiology of mitral disease was degenerative in 46%, rheumatic in 21%, ischemic in 18% and other in 15%. Concomitant cardiac procedures were performed in 283 patients (51%). Hospital mortality was 5.9% 133/560) overall and 2.5% (7/277) for isolated mitral reconstruction. Multivariate analysis revealed that NYHA classification, age, and associated coronary disease were significant predictors of increased operative risk. Late clinical and echocardiographic follow-up (f/u) was 98% complete, with a mean f/u interval of 3.5 years (range 1 month-14 years; total f/u 1,977 patient-years). Actuarial freedom from complications at 5 and 10 years was as follows: thromboembolic = 93% &86%, anticoagulant = 97% & 97%, endocarditis = 97%& 95%, reoperation = 90% & 83%; survival from all cardiac death was 85% & 77%, Pulmonary artery pressure, concomitant cardiac procedures, and associated coronary disease were predictive of late cardiac death by Cox regression analysis. Ten year freedom from reoperation was significantly better in nonrheumatic (90%) than in rheumatic patients (67%, p < 0.001). These data demonstrate durable long-term results and a continued low risk of late complications after mitral valve reconstruction using Carpentier techniques. This experience suggests that mitral valve reconstruction should be considered the procedure of choice for nonrheumatic patients with mitral valve insufficiency.