Comparative study between valve repair and replacement for mitral pure regurgitation. Early and late postoperative results.

Abstract

From May 1975 through December 1988, 91 patients (mean age 50.4 +/- 12.8 years) had first-time surgery for mitral pure regurgitation; 48 had mitral valve replacement (MVR) and 43 had valve repair. A majority of the patients had non-rheumatic valvular diseases. Those patients who underwent repair had less hemodynamic and functional derangement than those who underwent MVR. The operative mortality was 8.3% in the MVR group and 2.3% in the repair group. Seventeen percent of the MVR group and 2% of the repair group required intra-aortic balloon pumping support (p less than 0.03). A higher dose of dopamine and/or dobutamine during the early postoperative period was necessary in the MVR group (7.0 +/- 4.8 micrograms/kg/min) than in the repair group (5.1 +/- 3.1 micrograms/kg/min). Duration of respirator support for hospital survivors was longer in the MVR group (2.3 +/- 2.7 days) than in the repair group (1.4 +/- 1.0 days). There were 5 late deaths (2.2 +/- 1.0%/pt-yr) not counting 6 non-cardiac deaths in the MVR group and 1 (0.6 +/- 0.6%/pt-yr) in the repair group. There were 17 patients (7.5 +/- 1.8%/pt-yr) who experienced treatment failure in the MVR group and 5 (2.3 +/- 1.3%/pt-yr) in the repair group (p less than 0.02). Eight patients in the MVR group (3.5 +/- 1.3%/pt-yr) underwent repeat surgery in the late postoperative period, as did 3 (1.7 +/- 1.0%/pt-yr) in the repair group. There was no increase in the incidence of repeat surgery after valve repair. All the current survivors in the repair group, and 96% of those in the MVR group were in NYHA functional class I or II. These results indicate that mitral repair is the preferred operative procedure for pure mitral regurgitation, whenever it is possible.