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