Eur J Cardio-thorac Surg (1993) 7: 263-270 ca~i&rq-aLbx-aLb;ic surgery 0 Springer-Verlag zyxwvutsrqponml 1993 zyxwvutsrqpon Valve-related events and valve-related mortality in 340 mitral valve repairs A late phase follow-up study J. Fernandez, D. H. Joyce, K. J. Hirschfeld, C. Chen, S. S. Yang, G. W. Laub, M. S. Adkins, W. A. Anderson, J. W. Mackenzie, L. B. McGrath Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, 200 Trenton Road, Browns Mills, NJ 08015, USA Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA Abstract. To assess the early and late valve-related events, 340 consecutive patients undergoing mitral valve repair from 1969 to 1988 were evaluated. Follow-up was complete, with a mean of 7.5% years and range from 2 to 22 years (cumulative 2456 patient-years). There were 221(65%) female patients. Rheumatic valvular disease was present in 246 (68%) patients. The remaining patients had ischemic or congenital valve disease, floppy valve or infective endocarditis. At surgery, 47% of the patients had pure mitral incompetence, 43% had mixed mitral stenosis and incompetence and 10% had predominant mitral stenosis. Seventy-three percent of the patients were in functional class III or IV. Twelve percent had had prior heart surgery. Concomitant valve procedures including coronary revascularization were performed in 62.3%. There were 23 hospital deaths (6.8%) but only 3 of these (0.8%) were valve-related in patients who died at reoperation for valve repair failure. There were 4 other early repair failures who survived early reoperation. Of the 317 hospital survivors, there were 127 late deaths, and an actuarial survival of 44 & 3.7% (70% CL) at 14 years. Of these, 13 were valve-related or 0.5% patient-year. Late events included thromboembolism (TE) 1% patient-year, anticoagulant bleeding 0.4% patient-year, infective endocarditis (IE) 0.2% patient-year and late reoperation for mitral valve repair failure in 63 patients or 2.8% patient-year. At the late follow-up, 88% of the hospital survivors were in functional class I or II. The low incidence of both valve-related events and mortality reinforces our belief that mitral valve reconstructive procedures are durable and offer a good alternative to mitral valve replacement. [Eur J Cardio-thorac Surg (1993) 7:263-2701 Key words: Mitral valve reconstruction - Mitral valve repair In recent years there has been a renewed interest in mitral valve reconstruction as an alternative to valve replace- ment to treat mitral incompetence. Several reports have indicated the advantages of valve repair in terms of oper- ative mortality and incidence of late events and late sur- vival. However, the follow-up exceeds 10 years in only a few of these reports [4, 5, 11, 14, 191. Furthermore, the separation between total events and valve-related events is not always specified. Mitral valve reconstruction has been performed at our institution since the early days of cardiac surgery (1958) [2, 3, 201. A review of our total experience with mitral valve repair was undertaken to determine the valve-related mortality and late phase valve-related events over a 22-year period. Presented at the 6th Annual Meeting of the European Association for Cardio-thoracic Surgery, Geneva, Switzerland, September 14- 16, 1992 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Correspondence to: Javier Fernandez, MD Material and methods From January 1969 to December 1988, 340 patients underwent mitral valve reconstructive operations. The period of follow-up was extended to March 1991. The range was 2 to 22 years, with a mean of 7.75 years and an accumulation of 2456 patient-years. The fol- low-up was complete (100%). Various means of contact with the patients or their persona1 physicians, by direct interview or mail correspondence were utilized. Special emphasis was given to deter- mining the cause of death, whether the mortality was due to valve- related events or other factors. The Society of Thoracic Surgeons guidelines regarding the definition of mortality causes and valve-re- lated events were carefully followed. The clinical data from patients was recorded into special “data collection forms” and entered into a computerized database system (ORACLE) ‘. The data was then analyzed using SAS statistical software. The type of statistical analysis used depended on the data characteristics and information needed. The Fisher’s Exact Test or x2 test was used for analysis of discrete variables. The Wilcoxon’s Test was used for continuous variables. A P value equal to or less than 0.05 was considered significant. Hospital events were ex- 1 Oracle Corporation, Redwood Shores. CA 94065