Comparative Morbidity of Mitral Valve Repair versus Replacement for Mitral Regurgitation with and without Coronary Artery Disease

Abstract

Mitral valve repair has been increasingly used at our hospital for mitral regurgitation with and without coronary disease. From January, 1984, to June, 1987, of 338 patients undergoing all forms of mitral valve surgery, 140 had first-time surgery for pure mitral regurgitation: 75 had valve repair, and 65 had valve replacement. Thirty-three of 75 (44%) had concomitant coronary bypass in the repair group, while 21 of 65 (32%) had coronary bypass in the replacement group. The mean functional class (3.4 versus 3.5), age (60 versus 61 years), and preoperative hemodynamics were similar in both groups. The cause of mitral regurgitation in the repair group was myxomatous change in 32 patients, ischemia in 27, rheumatic valve disease in 12, and endocarditis in 4. A Carpentier ring was used in 46, a Duran ring was used in 11, and none was used in 18. The operative mortality was 3 of 75 patients (4%) in the repair group, all with coronary artery bypass grafting, versus 2 of 65 patients (3%) in the replacement group, 1 of whom had undergone coronary artery bypass grafting. The mean postoperative functional class 15 months postoperatively was 1.12 in the repair group versus 1.15 in the replacement group. There were 7 late deaths in the replacement group and only 3 late deaths in the repair group. Actuarial survival at 30 months was 85 ± 6% for the replacement group and 94 ± 4% for the repair group. There were 5 late emboli (1 fatal, 4 nonfatal) after valve replacement and none after valve repair ( p = 0.03). Actuarial freedom from incidence of emboli at 36 months was 86 ± 6 and 100%, respectively ( p = 0.03). Postoperative echocardiograms were done in 59 of 75 valve repair patients: The mean gradient was 3 mm Hg, the mean valve area was 2.92 cm 2, and 6 patients had greater than 2+ mitral regurgitation, all of whom required reoperation within the first few months after operation. These results indicate that morbidity after mitral valve repair was related to an early reoperation learning curve, while late mortality and incidence of thromboemboli were more frequent in the replacement group.