title: Durability of mitral valve repair for degenerative disease.
abstract: BACKGROUND
  Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the procedure of choice.
  
  
  OBJECTIVE
  This study was undertaken to identify factors influencing the durability of mitral valve repair.
  
  
  METHODS
  Between 1985 and 1997, 1072 patients underwent primary isolated mitral valve repair for valvular regurgitation caused by degenerative disease. Repair durability was assessed by multivariable risk factor analysis of reoperation. It was supplemented by a search for valve-related risk factors for death before reoperation. Three hospital deaths occurred (0.3%); complete follow-up (4152 patient-years) was available in 1062 of 1069 hospital survivors (99.3%).
  
  
  RESULTS
  At 10 years, freedom from reoperation was 93%. Among 30 patients who required reoperation for late mitral valve dysfunction, the repair failed in 16 (53%) as a result of progressive degenerative disease. Durability of repair was adversely affected by pathologic conditions other than posterior leaflet prolapse, use of chordal shortening, annuloplasty alone, and posterior leaflet resection without annuloplasty. Durability was greatest after quadrangular resection and annuloplasty for posterior leaflet prolapse and was enhanced by the use of intraoperative echocardiography. Death before reoperation was increased in patients having isolated anterior leaflet prolapse or valvular calcification and by use of chordal shortening or annuloplasty alone.
  
  
  CONCLUSIONS
  Repair durability is greatest in patients with isolated posterior leaflet prolapse who have posterior leaflet resection and annuloplasty. Chordal shortening, annuloplasty alone, and leaflet resection without annuloplasty jeopardize late results.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Gillinov
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: E H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: R
authors.initials: R
authors.lastname: Diaz
authors.forename: J H
authors.initials: JH
authors.lastname: Arnold
authors.forename: B W
authors.initials: BW
authors.lastname: Lytle
authors.forename: N G
authors.initials: NG
authors.lastname: Smedira
authors.forename: J F
authors.initials: JF
authors.lastname: Sabik
authors.forename: P M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: F D
authors.initials: FD
authors.lastname: Loop
mesh_terms: D002114:Calcinosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002423:Cause of Death; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome