title: Rheumatic mitral valve repair: 22-year clinical results.
abstract: OBJECTIVE
  Rheumatic mitral valve disease presents a surgical and a medical challenge to surgeons in the developing and developed world. Comprehensive reproducible repair techniques of the anatomic units in individual patients are required to restore the normal mitral valve anatomy and function.
  
  
  METHODS
  Between April 1986 and December 2009, a total of 2,211 patients underwent mitral valve repair at the authors' institution. Of these patients, 50 (32 women, 18 men) underwent repair at a median age of 45.6 years. Pure mitral stenosis was identified in four cases (8%), pure mitral regurgitation in 37 (74%), and mixed lesions in nine (18%). Posterior leaflet plication, Paneth posterior suture and autologous pericardial strip annuloplasty, chordal transfer and papillary muscle splitting were used to repair a rheumatically diseased mitral valve with leaflet prolapse, annulus dilatation and elongated or restricted chordae and malformed papillary muscle.
  
  
  RESULTS
  Three deaths (6%) occurred in hospital (< or = 30 days), and 14 late deaths occurred between 60 days and 14 years. The overall survival was 94.1 +/- 3.3%, 87.5 +/- 4.8%, 84.7 +/- 5.4%, 66.9 +/- 7.9% and 50.2 +/- 9.3% at 30 days and one, five, 10 and 15 years, respectively. Successful repair was achieved in 39 cases (78%). Actuarial freedom from severe mitral regurgitation and reoperation at one, five and 10 years was 92.7 +/- 4.1%, 77.3 +/- 7.2% and 53.4 +/- 9.6%, respectively, and was 78% for Paneth posterior suture and autologous pericardial strip annuloplasty at five and 10 years. The linearized rate for reoperation in the age groups < 20 years and > 20 years was 4.5%/pt-yr (range: 2.0-10.2%/pt-yr) and 4.3%/pt-yr (range: 2.5-7.2%/pt-yr), respectively.
  
  
  CONCLUSIONS
  Mitral valve repair in rheumatic disease is feasible, but the results are suboptimal. Pure mitral incompetence may be reparable and long-lasting, whilst mixed lesions may be reparable but fail subsequently. The predictability of repair and long-term functional results was determined by perioperative echocardiographic evaluation and the application of an appropriate repair technique to treat the complex pathology of the mitral valve apparatus.
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany. yankah@dhzb.de
authors.forename: Charles A
authors.initials: CA
authors.lastname: Yankah
authors.forename: Henryk
authors.initials: H
authors.lastname: Siniawski
authors.forename: Christine
authors.initials: C
authors.lastname: Detschades
authors.forename: Julia
authors.initials: J
authors.lastname: Stein
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult