Mitral valve repair in patients with rheumatic mitral insufficiency. Twenty years of techniques and results

Objective: Mitral valve repair in rheumatic patients is still a challenge. The aim of this study is to assess the results of mitral valve repair in rheumatic patients with rheumatic mitral insufficiency. Methods: 330 patients with rheumatic mitral insufficiency who had undergone mitral valve repair in the Heart Institute HC-FMUSP were assessed retrospectively, between 1985 and 2005. The mean age was 26.9 ± 15.4 years and 57.6% were female. On preoperative assessment, 39.5% of patients were in NYHA functional class IV. The most common techniques for repair employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures. Results: The hospital mortality was 0.9% (three patients), two of them children with active rheumatic fever. Linearized rates of thromboembolism, endocarditis, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6%. Freedom from reoperation in 20 years was 30.3 ± 11.1%. Conclusion: Mitral valve repair in rheumatic patients is a feasible procedure in correction of mitral insufficiency with low operative mortality. Descriptors: Mitral valve/surgery. Mitral valve insufficiency/surgery. Rheumatic fever. Resumo Objetivo: A plástica da valva mitral em pacientes reumáticos permanece um desafio. O objetivo deste estudo é analisar a técnica e os resultados da plástica da valva mitral em pacientes com insuficiência mitral reumática. Métodos: Foram analisados, retrospectivamente, 330 pacientes portadores de insuficiência mitral reumática submetidos à plástica da valva mitral no Instituto do Coração do HC-FMUSP, entre 1985 e 2005. A idade média foi de 26,9 ± 15,4 anos e 57,6% dos pacientes eram do sexo feminino. No pré-operatório, 39,5% dos pacientes estavam em classe funcional IV. As técnicas de plástica mais comumente utilizadas foram a anuloplastia posterior com tira de pericárdio bovino em 48,4% dos pacientes e a anuloplastia com anel de Carpentier em 22,6%. As técnicas associadas This study was carried out at Heart Institute at HC-FMUSP, São Paulo, SP, Brazil. Correspondence address: Pablo M. A. Pomerantzeff. Av. Dr. Enéas de Carvalho Aguiar, 44. Surgical Dept. São Paulo, SP, Brazil CEP: 05403-100. E-mail: [email protected] Article received on February 20th, 2009 Article accepted on August 31th, 2009