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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 665-674, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WW Angell, JH Oury and P Shah
The factors that make mitral reconstruction an attractive alternative to
valve replacement are increased anatomical valve orifice, preservation of
the valvular apparatus, improved longevity over porcine xenografts, and no
requirement for long-term anticoagulation. In our experience the majority
of patients with mitral regurgitation have degenerative valve disease. This
comparative series of patients operated on over a 10 year interval includes
72 with replacement and 112 with reconstruction. The average cross-clamp
times were 69 minutes for reconstruction and 44 minutes for replacement.
The hospital mortalities were 3.6% and 18.1%, respectively. Postoperative
valve areas as determined by Doppler echocardiography were 2.69 cm2 for
replacement and 2.67 cm2 for reconstruction (p = 0.9). The valve failure
rate was 2.0% per patient-year for reconstruction and there were no
failures in the replacement group. The reoperation incidence for
reconstruction was 20% at 10 years. The remaining patients, although
clinically well, had varying degrees of stable, nonprogressive mitral
regurgitation. Forty-five percent had mild to trivial regurgitation
detectable by echocardiographic studies. The decision between mitral valve
reconstruction and mitral valve replacement remains a highly controversial
issue. The failure of our data to demonstrate superior valve function for
patients with mitral regurgitation undergoing valve reconstruction suggests
a need for careful analysis of reconstruction with respect to effective
valve orifice and incidence of regurgitation.
ARTICLES
A comparison of replacement and reconstruction in patients with mitral regurgitation
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