OUTCOME OF PATIENTS AFTER SURGERY FOR MITRAL REGURGITATION
DUE TO ISOLATED MITRAL VALVE PROLAPSE. P.
Arunothayarah*, A. I. MacIsaac, V.M.
Jelinek, P. Fox, R.J. Whitbourn and A.C. Wilson. St Vincent's
Hospital, Melbourne. The optimal timing of surgery for pure, isolated mitral
regurgitation (MR) due to mitral valve prolapse (MVP) remains controversial. To determine the predictors of outcome following mitral
valve repair/replacement for MR due to MVP, data from consecutive patients
undergoing surgery from 1989 to 1998 was analyzed. Patients (Pts) with rheumatic disease, coronary artery grafting
or other valve surgery were excluded. All (100%) pts were followed up at a mean
3.0±2.5 yrs. Eighty-eight pts with a mean age of 64.0±11.0 yrs, 62
(70.5%, underwent either MV Repair (58, 65.9%), or MV replacement (30,
34.1%). All pts (100%) had severe
mitral regurgitation, due to prolapse of the posterior leaflet (54, 61.4)
anterior leaflet (11,12.5%) or both leaflets (23, 26.1%). Thirty (34.1%) pts had mild symptoms (NYHA
Class I/II and 58 (65.9%) were Class III/IV.
Surgery was precipitated by chordal rupture in 35 (39.8%), onset of atrial fibrillation 34 (38.6%), endocarditis
2 (2.3%), ventricular arrhythmias 3 (3.4%), and other 14 (15.9%). No pt had pre-op FS <25 (mean FS 38.9 ±
6.6), mean LVEDD was 62.9 ± 7.4 mm, and mean LA diameter 54.6 ± 8.8 mm. There were no in-hospital deaths. A follow up, 4 pts had
redo MV surgery, 3 within 6 months, and 1 pt at 9 years. Eight pts died during
follow up (5 cardiac deaths).
Seventy-nine *89.7%) were Class I/II and 9 (10.3%) were class
III./IV. The only predictors of post
operative Class II/IV or cardiac death was anterior or bileaflet prolapse
(p=0.03). In this study there was zero
in-hospital mortality and excellent post operative outcomes. The only predictor of adverse outcome was
the pre-operative mitral leaflet pathology.
