Clinical Results of Reconstructive Surgery of the Mitral Valve

Abstract

In a four-year period, 720 open cardiac valvular surgical procedures were performed in Kosuyolu Heart and Research Center. In 120 of these 720 cardiac valvular operations, mitral valve reconstruction was performed alone or with other cardiac procedures. The youngest patient was twelve years old and the ol dest was eighty-eight with an average age of thirty-eight. All of the patients but 2—1 with congenital mitral valve lesion and the other with ischemic mitral valve lesion—had rheumatic mitral valve lesions; 80% of the patients were in the third and fourth functional class according to NYHA classification, and nearly 60% of the patients had some other cardiac lesions in addition to the mitral valve lesion. In 60 of the patients some other cardiac surgical procedures were per formed in addition to mitral valve reconstruction. The dominant lesions of the mitral valve were as follows: stenosis, 45%, insufficiently, 15%; and combined lesions, 40%. The authors used 12 different reconstruction techniques alone or in combi nation with each other in all of the patients. Among these techniques, they used mostly Carpentier's ring implantation. In-hospital mortality was 6%. One pa tient died in the late postoperative period. Three patients had reoperations be cause of unsuccessful reconstruction. Nonfatal thromboembolism occurred in 1 patient. All living patients were reevaluated periodically in the postoperative period. In all these patients mitral valve functions were studied clinically, echocardiographically, and/or hemodynamically. In 80% of the living patients, the reconstruction was successful and in 20% it was partially successful; 95% of the living patients improved their functional class to I or II. In conclusion, mitral valve reconstruction is a good alternative to replacement in selected pa tients in an experienced center.