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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 208-219, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ME Sand, DC Naftel, EH Blackstone, JW Kirklin and RB Karp
A total of 101 reparative and 389 valve replacement operations, isolated or
combined with tricuspid annuloplasty or operations for coronary artery
disease, were done for mitral incompetence (1975 to July 1, 1983). The
patients undergoing repair as a group were younger and had less hemodynamic
and functional derangement than those undergoing replacement. The
prevalence of repair was less (p less than 0.001) for two surgeons than for
the other four, even when possible differences in patient populations were
taken into account by multivariate analysis. Five-year survival rate,
including hospital deaths, was 76% after valve repair and 56% after valve
replacement (p = 0.005). However, by multivariate analysis, valve
replacement rather than repair was only possibly (p = 0.14) a risk factor.
(Multivariate analysis in all patients undergoing mitral valve repair in
the period 1967 to 1985 [n = 210] did not find the type of annuloplasty to
be a risk factor.) The incidence of reoperation was no different after
repair or replacement and there was no increase in the risk of reoperation
late after repair. Endocarditis early or late after operation occurred in
11 of the 389 patients undergoing mitral replacement and in none of those
undergoing repair (p = 0.08). The functional status of the patients was not
different between the two groups. These data, and the experience of others,
indicate the advantages of repairing rather than replacing the incompetent
mitral valve whenever possible.
ARTICLES
A comparison of repair and replacement for mitral valve incompetence
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