Mitral valve repair in rheumatic patients with mitral insuficiency: twenty years of techniques and results.

OBJECTIVE Mitral valve repair in rheumatic patients is still a challenge. The purpose of this study is to analyze the results of mitral valve repair in rheumatic patients in the Heart Institute University of Sao Paulo Medical School. METHODS Were analyzed retrospectively, between 1985 and 2005, 330 patients submitted to mitral valve repair in the Heart Institute of São Paulo. The mean age was 26.9 +/- 15.4 years and 57.6% were female. According do clinical evaluation, 39.5% of patients were in NYHA functional class IV. The most common techniques 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 in children with active rheumatic fever. Linearized rates of thromboembolism, endocardite, 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 conservative surgery in rheumatic patients is a feasible procedure with low operative mortality.