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[The surgical treatment of chronic ischemic mitral insufficiency]
R Scrofani1, A Cialfi, S Ravagnan
1Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale L. Sacco, Milano.
Insights
Surgical treatment for chronic ischemic mitral regurgitation (CIMR) is feasible with acceptable risks. Mid-term results show favorable functional outcomes, though the best surgical approach (repair vs. replacement) remains debated.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Research
Background:
- Chronic ischemic mitral regurgitation (CIMR) presents a high-risk surgical challenge.
- Evaluating the efficacy of surgical interventions for CIMR is crucial for patient outcomes.
Purpose of the Study:
- To assess the short- and long-term results of surgical treatment for chronic ischemic mitral regurgitation (CIMR).
Main Methods:
- A retrospective study of 46 patients undergoing mitral valve replacement or repair for CIMR between 1989 and 1997.
- Procedures included myocardial revascularization in 91.3% of patients.
- Preoperative assessment included echocardiography, New York Heart Association (NYHA) functional class, and ejection fraction (EF).
Main Results:
- Overall operative mortality was 8.6%, with higher mortality for valve replacement (16.6%) than repair (5.8%).
- Postoperative morbidity included low output syndrome (15.2%) and cerebral embolism (4.3%).
- At a mean follow-up of 27.6 months, 86.4% of patients achieved I-II NYHA functional class, with two late deaths.
Conclusions:
- Surgical treatment for CIMR is achievable with acceptable operative risks.
- Mid-term functional and clinical outcomes are promising.
- The optimal surgical strategy, whether valve repair or replacement, requires further investigation.
Background:
Operative correction of chronic ischemic mitral regurgitation (CIMR) is associated with a high-risk approach. The objective of this retrospective study was to evaluate the short- and long-term results of surgical treatment of CIMR.
Methods:
From 1989 to 1997, mitral valve replacement or repair was performed on 46 patients with CIMR. The average age range was 63.7 +/- 6.9; 8 patients were females; 30 patients (65.2%) were in New York Heart Association (NYHA) functional class III or IV; 4 patients (8.6%) were in chronic atrial fibrillation and preoperative myocardial infarction was lower in 23 patients (50%). Preoperative echo-Doppler analysis showed severe mitral insufficiency in 15 patients (32.6%). Preoperative mean pulmonary artery pressure (PAP) was 33.6 +/- 13.6 mmHg, mean ejection fraction (EF) 37.8 +/- 13.5%. Mitral valve replacement was performed in 12 patients (26%). Mitral valve repair was performed in 34 patients (73.9%). Myocardial revascularization was performed in 42 patients (91.3%) (mean graft/patient 2.2 +/- 0.8); aneurysmectomy was performed in 5 patients (10.8%), and in 2 patients (4.3%) tricuspid insufficiency was corrected by performing annuloplasty.
Results:
The overall operative mortality was 8.6% (4 patients). The operative mortality for repair was 5.8% (2 patients) and for replacement was 16.6% (2 patients). One patient was reoperated three days after first operation due to annuloplasty dehiscence. Postoperative morbidity included low output syndrome in 7 patients (15.2%), bleeding in 2 patients (4.3%), and cerebral embolism in 2 patients (4.3%). The mean length of stay in intensive care was 6.5 +/- 10.5 days. Follow-up (mean 27.6 +/- 3.3 months) was 88% complete and revealed good functional and clinical results: 86.4% of the patients in I-II NYHA class. One patient was reoperated due to mitral insufficiency progression. Two late deaths occurred, one due to acute myocardial infarction and the other to lung cancer.
Conclusion:
While long-term follow-up is mandatory, our results suggest that: a) surgical treatment of CIMI is feasible with acceptable operative risks; b) mid-term functional and clinical results are favorable; c) the choice of treatment--valve replacement or repair--is still debatable.