Reconstructive surgery for mitral and tricuspid valves--principles and personal experience

We have experienced 246 cases of reconstructive surgery for mitral and tricuspid valves, with 17 deaths in the immediate post-operative period or during follow-up. This gives an overall mortality rate of 6.9 per cent whereas in 72 cases of mitral valve reconstruction we recorded only 2 deaths i.e. a mortality rate of 2.7 per cent although the post-operative period remains relatively short. Thus, we feel fully justified in pursuing our conservative surgery program, especially for younger patients who, given their superior myocardial state, can lead a fuller life after mitral reconstruction than after mitral replacement. It is our conviction that mitral and tricuspid valve reconstruction should not be overlooked and that prior to resection and replacement, the surgeon and the team should pause and scrupulously examine the valvular components with a view to conservative surgery. For certain lesions, reconstruction can be carried out rapidly and reliably. The mortality rate is not higher than conventional cardiac surgery and the patient's long term prognosis is considerably improved.