Cirugía de la insuficiencia mitral isquémica / Surgery for ischemic mitral regurgitation

ABSTRACT

Background. Ischemic mitral regurgitation (IMR) is a severe condition which may be best treated by surgery, nowithstanding a relatively high mortality rate. Objectives. To evaluate the results of mitral valve replacement or repair in patients with IMR. Patients and methods. Retrospective review of the clinical records in 29 patients with IMR who were surgically treated from 1990 to 1999. They represent 8 percent of surgical procedures on the mitral valve. Results. Mean age was 67 ñ 9 years. Surgery was performed urgently in 19 patients (66,5 percent). NYHA functional class was 3.4 ñ 0.8. The mechanism of IMR was annular dilatation and spreading of papillary muscles in 18 patients, papillary muscle rupture in 9 and fibrosis in 2. Mitral valve replacement was performed in 14 patients and mitral valve repair in 15. Twenty four patients (83 percent) had concomitant myocardial revascularization. Overall surgical mortality was 24 percent; 26 percent for mitral replacement and 13 percent for mitral valve repair (p=0.215). On follow up of 26ñ33 months, one year survival was 76ñ0.8 percent and 5 years survival was 59ñ12 percent. Excluding in hospital mortality, survival was 100 percent at one year and 78ñ14 percent at 5 years. Functional class improved in all survivors, to 1.4ñ0.5. Late echocardiographic evaluation of patients with mitral valve repair showed absence of mitral regurgitation in 58 percent, 1+ MR in 17 percent and 2+ MR in 25 percent. Conclusion. In spite of a high perioperative mortality, surgery for IMR is a valuable procedure for patients with an otherwise highly lethal disease