Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica / Long-term results of mitral valve repair for ischemic mitral insufficiency

Background: The preferred treatment for ischemic mitral insufficiency is mitral valve repair with a prosthetic ring, because it does not deteriorate left ventricular function, allowing better immediate and long-term results. Aim: To assess long-term results of mitral annuloplasty with a prosthetic ring for ischemic mitral insufficiency. Patients and Methods: One hundred patients (68 men), with a mean age of 65.7 ± 8.6 years were included. They underwent a mitral annuloplasty with a prosthetic ring to treat ischemic mitral insufficiency, between February 1992 and May 2009. Fortyfour had a history of prior myocardial infarction and 46 had an evolving acute coronary syndrome. The inferior left ventricular wall was involved, exclusively or associated with an adjacent wall, in 72 cases. Coronary artery bypass grafts were performed in 92 patients and 32 required intra-aortic balloon pumping at some time during the peri-operative period. Results: Operative mortality was 10% (10 patients). During follow-up 30 patients died, at an average of 39 months after surgery (range: 3-142 months). Actuarial long-term survival rates at 1, 3 and 5 years were 79%, 72% and 64.5%, respectively. Trans esophageal echocardiogram performed in the operating room showed none or minimal residual mitral insufficiency in 96% of the cases. Echocardiographic follow-up was completed in 80% of the survivors; 79% of them had no or minimal mitral insufficiency. Only one patient was re-operated on due to severe mitral insufficiency and 4 required a permanent pacemaker. Conclusions: Considering the critical illness of these patients, good long-term results were observed after treatment of ischemic mitral regurgitation performing a mitral annuloplasty with a prosthetic ring.

Cirugía de la rotura de músculo papilar por infarto miocárdico / Surgery of post myocardial infarction papillary muscle rupture

Background: Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. Aim: To analyze our most recent surgical experíence with papillary muscle rupture. Patients and Methods: The datábase of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. Results: Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2 percent of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study períod. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class III. Conclusions: Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and ¡ong-term mortality. However, survivors have good quality of life.