title: Case-matched comparison of mitral valve replacement and repair.
abstract: Carpentier's techniques of prosthetic ring mitral valve repair for mitral regurgitation offer the potential for immediate and long-term improvement in valve function without the necessity of replacing the native valve with a prosthesis. A consecutive, case-matched series of 65 patients with prosthetic ring mitral valve repair was compared with 65 patients undergoing mitral valve replacement for mitral regurgitation. The aortic cross-clamp time was 57 +/- 33 minutes in the repair operations and 41 +/- 25 minutes in the replacement operations (p = 0.003). The cardiopulmonary bypass time was 154 +/- 44 minutes in the repair operations and 113 +/- 41 minutes in the replacement operations (p = 0.0001). There were no myocardial infarctions in the hospital in either group. Hospital death was noted in 1.5% of repairs and 4.6% of replacements (p = not significant). Survival at 4 years was 0.84 for repairs and 0.82 for replacements (p = not significant). Freedom from reoperation to replace the mitral valve at 4 years was 62 of 65 patients in the repair group and 64 of 65 patients in the replacement group (p = not significant). In-hospital and midterm results in a closely matched population show that mitral valve repair yields results comparable with those of replacement despite a more difficult procedure. The benefits of maintaining the native valve with chordal and papillary muscle structure intact and avoidance of prosthetic valve implantation may then become apparent with longer follow-up.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: J M
authors.initials: JM
authors.lastname: Craver
authors.forename: C
authors.initials: C
authors.lastname: Cohen
authors.forename: W S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D016022:Case-Control Studies; D002815:Chordae Tendineae / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications; D011474:Prosthesis Design; D012008:Recurrence