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Ischemic mitral valve repair surgery.

U O von Oppell1, F Stemmet, J Brink

  • 1Department of Cardiothoracic Surgery, University of Cape Town, South Africa.

The Journal of Heart Valve Disease
|March 4, 2000
PubMed
Summary
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Mitral valve repair for ischemic mitral regurgitation showed no difference between suture and ring annuloplasty. Preoperative severe regurgitation and poor ejection fraction predicted worse outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair
  • Ischemic Heart Disease Management

Background:

  • Management of concomitant moderate or severe ischemic mitral regurgitation (iMR) in ischemic heart disease (IHD) is crucial for long-term prognosis.
  • Mitral repair via suture or ring annuloplasty is advocated, but superiority of either method remains unestablished.

Purpose of the Study:

  • To evaluate the outcomes of mitral valve repair in patients with iMR undergoing combined coronary artery bypass grafting (CABG) and mitral valve surgery.
  • To compare the effectiveness of suture versus ring annuloplasty in mitral valve repair for iMR.

Main Methods:

  • Retrospective review of 63 patients who underwent combined CABG and mitral valve repair for iMR between 1996 and 1998.
  • Mitral repair was performed using either suture annuloplasty (84%) or ring annuloplasty (16%).

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  • Outcomes assessed included operative mortality, functional class, regurgitation severity, and long-term survival.

    • Main Results:

    • Operative mortality was 12.7%. Requirement for intra-aortic balloon pumping predicted mortality.
    • At discharge, 98.2% of patients were in NYHA class I or II. Moderate regurgitation occurred in 9.5% of patients.
    • Predictive factors for poor outcome included preoperative severe iMR, poor left ventricular ejection fraction (LVEF), and surgeon experience. Structural valvular deterioration occurred in 21.8% of survivors.

    Conclusions:

    • The type of annuloplasty (suture vs. ring) did not significantly influence patient outcomes.
    • Severe preoperative iMR, low LVEF, and surgeon's experience are critical predictors of poor outcomes after mitral valve repair.
    • Long-term structural valve deterioration remains a concern, necessitating further investigation into risk factors and management strategies.