Surgical treatment of ruptured mitral valve chordae. A comparison between valve replacement and valve repair.

Sixty-five patients were treated for ruptured mitral valve chordae from January, 1976, to December, 1981; 21 patients underwent valve reconstruction (group A) and 44 underwent valve replacement (group B). Both groups had a mean age of 62 years with an overall male: female ratio of 2:1. Eighty-one percent of group A and 73% of group B presented in clinical class III/IV (NYHA). Chordal rupture was spontaneous in 76% (group A) and 61% (group B) respectively, with posterior leaflet chordal involvement in most patients. The operative mortality was 6.8% (3 deaths) in group B with no early death in group A (p less than 0.001). More than 85% of both groups were in class I/II (NYHA) postoperatively. The actuarial survival at 5 years was 85% in group A and 78% in group B. No emboli occurred in group A while an actuarial incidence of freedom from emboli of 76% at 5 years was observed in group B (p less than 0.046). One patient (4.8%) in group A was reoperated for failed valve repair. The patients with repaired valves were assessed by echocardiography. The peak rates of dimension change of the left ventricular cavity were in the normal range in all but 3 patients, while the left ventricular and end-diastolic dimensions were significantly reduced (p less than 0.005). We conclude that valve reconstruction provides an improved functional result in patients with ruptured mitral chordae in addition to an increased event-free survival.