MITRAL VALVULOPLASTY, A BETTER ALTERNATIVE - COMPARATIVE-STUDY BETWEEN VALVE RECONSTRUCTION AND REPLACEMENT FOR RHEUMATIC MITRAL-VALVE DISEASE

Valvuloplasty is now a well accepted alternative method of surgical treatment of mitral valve disease. To analyse its relative performance inrheumatic valvulopathies, three groups of patients who had mitralvalvuloplasty (1980–1984; 241 patients) or mitral valve replacement with mechanical (1980–1984; 386 patients) or biological prostheses (1976–1980;289 patients) were reviewed. The early mortality was 3.3% forvalvuloplasty, 7.8% for mechanical valve replacement and 6.6% for bioprostheses (P < 0.05). Late mortality occurred at the rate of2.6% per patient year (15 patients) for valvuloplasty, 5.7% per patientyear (70 patients) for mechanical valves and 7.4% per patient year (41 patients) for bioprostheses (P < 0.01), but valve- relatedmortality was 1.0% per patient year, 2.5% per patient year and 4.2% perpatient year, respectively (P < 0.01). Reoperation was more frequent after valve replacement with bioprostheses (6.7% per patient year)than after valvuloplasty (4.3% per patient year) and after mechanical valvereplacement (1.5% per patient year; P < 0.02), and was necessitatedmainly by residual or recurrent valve dysfunction after valvuloplasty, bland or infected periprosthetic leaks in mechanical valves and degradationof bioprostheses. Valve failure occurred at the rate of 6.1% per patient year for valvuloplasty, 5.7% per patient year for mechanical valves and 11.1% per patient year for bioprostheses (P < 0.05). In actuarialterms, global survival and survival free from valve related complicationswere 90% ± 4% and 70% ± 6% for patients who had valvuloplasty, 76% ±3% and 71% ± 5% for the mechanical prosthetic replacement group and 62%± 7% and 30% ± 7% for bioprosthetic valve replacement. © Springer-Verlag.