Prosthetic Replacement of the Mitral Valve

The late postoperative results of isolated mitral valve replacement in 100 patients operated upon from 1961 to 1965 are summarized. Eighty-three of the patients survived operation, and 52 are still alive. Seventy-six percent of patients surviving operation were alive 5 years later, and 64% after 8 years. Of the entire group of 100 patients operated upon, 63% were alive after 5 years and 51% after 8 years. Sixteen of the 31 late deaths were definitely attributable to the presence of the prosthesis: systemic arterial emboli (eight patients), valve thrombosis (two), perivalvular leak (one), ball variance (two), endocarditis (two), and intracerebral hemorrhage due to anticoagulants (one). Congestive heart failure was the primary cause of death in the remaining patients. Predominance of either stenosis or regurgitation preoperatively did not significantly alter late survival, nor did coexistent tricuspid regurgitation. High operative and early postoperative mortality was seen in patients with associated aortic regurgitation. Patients who were in class IV preoperatively had a higher mortality (50% alive at 5 years) than those in class III (70% alive), but no difference in mortality was noted between patients who preoperatively had normal sinus rhythm and those who had atrial fibrillation. Forty-nine percent of patients have sustained systemic emboli, and these have occurred throughout the postoperative period. Currnetly, 50% of patients are class I, 42% are class II, and only 8% are class III. Prosthetic mitral valve replacement has provided gratifying long-term symptomatic improvement in the majority of patients.