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J Thorac Cardiovasc Surg 2008;136:1503-1509
© 2008 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Mitral valve repair for advanced myxomatous degeneration with posterior displacement of the mitral annulus

Division of Cardiovascular Surgery of the Peter Munk Cardiac Centre at the Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada

Received for publication February 29, 2008; revisions received May 4, 2008; accepted for publication May 20, 2008.

^_* Address for reprints: Tirone E. David, MD, 200 Elizabeth St–4N457, Toronto, Ontario M5G 2C4, Canada. (Email: tirone.david{at}uhn.on.ca).

Objective: This study examines the outcomes of mitral valve repair in a defined group of patients with mitral regurgitation caused by advanced myxomatous degeneration.

Methods: Advanced myxomatous degeneration of the mitral valve was defined as a degenerative process whereby both leaflets are voluminous and aneurysmal and the mitral annulus diameter exceeds 40 mm and has posterior displacement, as determined by means of echocardiographic analysis. Over a 16-year period, we identified 183 patients who underwent valve repair in this subgroup of myxomatous degeneration. The repair consisted of relocating the posterior mitral annulus to the endocardium of the left ventricle at the atrioventricular junction, correction of leaflet prolapse, and annuloplasty. Analysis of perioperative variables and postoperative outcomes were undertaken. The mean follow-up was 5.9 ± 4.2 years and complete.

Results: The patients' mean age was 52 years, and 118 were men. All patients had mitral regurgitation preoperatively. There were no early and only 8 late deaths (2 valve-related deaths). The survival at 10 years was 92% ± 3%. Six patients required reoperation on the mitral valve, 5 for recurrent severe mitral regurgitation. The freedom from reoperation at 10 years was 93% ± 3%. Six patients had severe and 21 had moderate mitral regurgitation. The freedom from recurrent moderate or severe mitral regurgitation at 10 years was 80% ± 5%. We could not identify independent predictors of recurrent mitral regurgitation.

Conclusions: Mitral valve repair for advanced myxomatous degeneration on the mitral valve provides excellent early functional results, but late recurrent regurgitation is common, despite correction of dilated and displaced mitral annulus and leaflet prolapse.

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