Surgical treatment of mitral regurgitation caused by floppy valves: repair versus replacement.

Between October 1969 and April 1980, 132 patients underwent operation for floppy mitral valve. The 46 patients in group A underwent valve replacement using an inverted, fresh, unstented, antibiotic-sterilized aortic homograft and the 86 patients in group B underwent valve repair. The onset of symptoms was sudden. More than 80% of the patients in both groups were in New York Association functional class III or IV. The dominant lesion in both groups was ruptured chordae to the posterior cusp (72% in group A and 58% in group B). There were five early deaths (11%) and 15 late deaths (32%) in group A and four early deaths (5%) and five late deaths (7%) in group B. The actuarial survival rate at 5 years was 62% in group A and 90% in group B. In group A, five patients (11%) had valve failure, which led to late death in two. Four patients (8%) in group A required reoperation. Two patients in group B developed a loud mitral systolic murmur soon after operation and required reoperation. Two patients in group B had thromboembolism before routine anticoagulation. Sixteen patients (61%) in group A and 56 (76%) in group B were functional class I after operation.