Green Lane Hospital experience with mitral valve repair for prolapse: adverse outcomes for highly symptomatic patients.
OBJECTIVE
Valve repair, where suitable, is the preferred option in patients who require mitral surgery. A number of studies have shown excellent long-term results, but most were undertaken in tertiary referral centers with a high throughput of patients.


METHODS
We present our experience in 60 patients, aged 60 +/- 14 years, undergoing repair between 1984 and 1993. Most patients (83%) were in New York Heart Association (NYHA) class II or III at the time of surgery; 27% had concomitant ischemic heart disease. Almost all (98%) had posterior leaflet repair and 18% had anterior leaflet repair. Eight surgeons each performed a mean of 7.5 operations during this period.


RESULTS
The 30-day mortality rate was 3.3%. There were seven late deaths. Five patients underwent reoperation for mitral regurgitation (two early, three late). At six years, 60% of patients were alive, or free of stroke or reoperation. Late follow up was obtained in 45 of 47 surviving patients: 95% were in NYHA class I or II; one-third were on anticoagulants for atrial fibrillation; 90% had mild (or less) mitral regurgitation on echocardiography.


CONCLUSIONS
These data show that most patients have a very good outcome from valve repair surgery and encourage the trend towards operating earlier in the course of the disease. Adverse outcomes occurred mainly in patients who were highly symptomatic at the time of surgery. The high proportion of patients on postoperative anticoagulants underscores the importance of operating before atrial fibrillation becomes permanent.
O'Meeghan
T J
TJ
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
Jaffe
W M
WM
Raudkivi
P J
PJ
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D008945:Mitral Valve Prolapse / Q000401:mortality* / Q000601:surgery*; D009520:New Zealand / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants