Resultados alejados de la cirugía reconstructora de la insuficiencia mitral / Long term results of reconstructive surgery for mitral insufficiency

ABSTRACT

Background: Surgical repair is the procedure of choice for mitral insufficiency since it preserves better left ventricular structure and function. Aim: To assess the long term clinical and echocardiographic results of mitral valve reconstructive surgery. Material and methods: A review of clinical and echocardiographic data of 68 patients (34 male, age range 17 to 82 years), subjected to surgical mitral valve repair between december 1991 and march 1998. Preoperative functional capacity of these patients was 2.96 ñ 0.7. Surgical repair was assessed using transesophagic echocardiography in all subjects. Results: The etiology of mitral insufficiency was degenerative in 43 patients, rheumatic in 10, infectious in 6, ischemic in 5 and miscellaneous in 4. The most frequent pathological findings were dilatation of the mitral ring in 42 percent of patients, chordae tendinae rupture in 32 percent and enlargement in 24 percent. A mitral anuloplasty was done in 90 percent of patients, a cuadrilateral resection of posterior leaflet in 52 percent and chordae tendinae transference in 12 percent. An additional surgical procedure was done in 34 percent of subjects. Three patients died during hospitalization (4.4 percent). During the follow up of 36.5 ñ 22.3 months, five patients died and one required a mitral valve replacement. The actuarial survival probability was 95.3 ñ 2.6 percent at one year and 83.5 ñ 6.5 percent at five years. The reoperation free survival was 100 percent at one year and 97.4 ñ 2.5 percent at five years. At the end of follow up the functional capacity improved to 1.25 ñ 0.4. echocardiography showed absence of mitral insufficiency in 48.4 percent of patients, minimal, mild and moderate insufficiency in 35.5, 14.5 and 1.6 percent of patients respectively. Conclusions: Surgical valve reconstruction in mitral insufficiency has satisfactory long term results and should be the procedure of choice for eligible patients