Surgical treatment of degenerative mitral regurgitation.

Between October 1965 and April 1975, mitral valve replacement was preformed in 66 patients with myxomatous degeneration of the mitral valve ("floppy valve syndrome"). Operative mortality was 6 percent (four patients). Current evaluation was obtained for all patients; the average postoperative follow-up interval for surviving patients was 3.5 years (range 1 month to 9.9 years); the total duration of postoperative follow-up for all patients was 180 patient-years. Overall survival rates, calculated by the actuarial method, were 81, 68 and 50 percent, respectively, 1, 2 and 5 years after mitral valve replacement. Preoperative variables with a significantly adverse effect on patient survival included patient age greater than 50 years, New York Heart Association functional class IV, left ventricular end-diastolic pressure greater than 12 mm Hg and mean pulmonary arterial wedge pressure greater than 16 mm Hg. Support is advanced for the concept that mitral valve dysfunction associated with myxomatous degeneration constitutes a broad spectrum of clinicopathologic involvement. Acute clinical and hemodynamic deterioration may often occur in the setting of chronic mitral valve dysfunction. Postoperative mortality is directly related to preoperative functional disability and hemodynamic evidence of impaired left ventricular function. Consideration should be given to earlier operative intervention in patients with myoxmatous mitral degeneration and mitral insufficiency before severe and probably irreversible impairment of ventricular function occurs.