[Surgical treatment of acquired mitral valve diseases--five-year analysis of early and late results].
The indications for mitral valve repair or mitral valve replacement are worldwide accepted, but they still depend of the personal experience of the surgeon and the tradition in the respective cardio-vascular clinic. Valve repair had many advantages over the replacement, but the long-term durability and the reoperations remain a major problem. In this retrospective review we examine the five years results of the surgical treatment of mitral valve diseases and the factors influencing the choice of the operation, the mortality and morbidity.


METHODS
From January 1998 to December 2002, 76 patients underwent mitral valve repair and 194 underwent mitral valve replacement. The mean age was 50.6 years, and 52.8% were NYHA class III or IV. The causes of mitral valve disease were ischemic in 45, rheumatic in 133, degenerative in 68 and endocarditis in 18 patients. Mitral valve repair was accomplished by Carpentier's techniques, Key, Alfeiri or ring implantation and mitral valve replacement with mechanical or biologic valve.


RESULTS
In the ischemic group early mortality occurred in 7 patients (15.5%), in endocarditis group in 3-16.6%, in degenerative group in 2 (2.9%) and in the rheumatic group in 3 (2.2%). Overall mortality in the replacement group was 5.1% and in the repair group (6.5%). Six patients needed reoperation in the repair (7.8%) and 12 patients in the replacement group (6.1%). Survival at 5 years was 90% in the repair and 83% in replacement patients.


CONCLUSIONS
Mitral valve repair are used almost always in ischemic and degenerative etiology, but they also show good results and long-term survival in cases of rheumatic mitral valve disease. The ischemic etiology, endocarditis and bad function of the left ventricle are the most important predictors for early death and poor long-term survival.
Baev
B
B
Nikolov
D
D
Nachev
G
G
Chirkov
A
A
D006348:Cardiac Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome