Mitral valve surgery for chronic ischemic mitral regurgitation

Early and midterm clinical and echocardiographic results after mitral valve (MV) surgery for chronic ischemic mitral regurgitation were investigated to evaluate the validity of the criteria for repair or replacement applied by us. From 1988 to 2002, 102 patients with ischemic mitral regurgitation underwent MV surgery (82 repairs and 20 replacements). End-systolic distance between the coaptation point of mitral leaflets and the plane of mitral annulus was the key factor that allowed either repair (≤10 mm) or replacement (>10 mm). Patients who had MV replacement showed higher New York Heart Association class (3.2 ± 0.5 versus 3.4 ± 0.5; p = 0.016), lower preoperative ejection fraction (0.33 ± 0.9 versus 0.38 ± 0.12; p = 0.034), and higher end-diastolic volume (161 ± 69 mL versus 109 ± 35 mL; p < 0.001) compared with repair. Mitral regurgitation was 3.2 ± 0.7 in both groups. Thirty-day mortality was 3.9% (2.4% MV repair versus 10.0% MV replacement; not significant). During the follow-up 26 patients died. Of the 72 survivors, 55 (76.3%) were in New York Heart Association classes I and II. Five-year survival was 75.6% ± 4.7% in MV repair and 66.0% ± 10.5% in MV replacement (not significant). Survival in New York Heart Association classes I and II was 58.9% ± 5.4% in MV repair and 40.0% ± 11.0% in MV replacement (not significant). Cox analysis identified preoperative New York Heart Association class, ejection fraction, end-diastolic volume, end-systolic volume, and congestive heart failure as risk factors common to both events. In 46 patients, late echocardiograms showed no volume or ejection fraction modifications. In patients who underwent MV repair, 50% had no or mild mitral regurgitation. Correction of chronic ischemic mitral regurgitation through either repair or replacement provides a good 5-year survival rate, with more than 75% of the survivors in New York Heart Association classes I and II.