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Analysis of Recurrent Mitral Regurgitation after Mitral Valve Repair

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

For reprint information contact: Jae Won Lee, MD Tel: 82 2 3010 3580 Fax: 82 2 3010 6966 Email: jwlee{at}amc.seoul.kr, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, South Korea.

Mitral valve repair was performed in 437 patients with mitral regurgitation from January 1994 to January 2002. The causes of mitral regurgitation were degenerative in 238 (54%), rheumatic in 134 (31%), and others in 65 (15%). The most frequently employed surgical techniques were ring annuloplasty in 417 (95%) cases, new chordae formation in 216 (50%), and quadrangular resection in 117 (27%). The mean follow-up was 29.04 ± 22.81 months. There were 5 (1.2%) early and 5 (1.2%) late deaths. The reoperation rate was 1.6% with 41 (9%) cases of recurrent mitral regurgitation. Of these 22 were procedure-related: incomplete repair in 13, discordant new chordal length in 7, suture dehiscence and leaflet perforation in 1 case each. There were 19 cases of valve related failures: progression of rheumatic disease in 18 and subacute infective endocarditis in 1. Valve-related failure strongly correlated with progression of rheumatic disease. As initial operative success was the prime determinant of repair durability, intraoperative repair assessment with transesophageal echocardiography was essential.

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