Mitral valve surgery for mitral regurgitation in patients with advanced dilated cardiomyopathy

Unfortunately, mitral valve surgery for mitral regurgitation (MR) in patients with advanced dilated cardiomyopathy is generally associated with a high operative risk and a poor outcome. Some authors believe that only heart transplantation is the really effective surgical treatment. We analyzed our clinical and echocardiographic results after mitral repair or replacement in this difficult subset of patients.

From September 1998 to May 2001, 24 consecutive patients (mean age 65.7 +/- 11.0 years) with MR > 2+ and advanced dilated cardiomyopathy (left ventricular ejection fraction < 0.35) underwent mitral repair (n = 11) or replacement (n = 13). The cause of left ventricular dysfunction was ischemic in 17 patients and idiopathic in 7. Myocardial revascularization was performed in all patients with ischemic disease. NYHA functional class IV was present in 21 patients (87.5%) and urgent surgical priority in 14 (58.3%). The mean follow-up was 26.7 +/- 11.8 months.

One patient died (4.2%) of myocardial infarction 5 days after operation. The mean hospital stay was 10.6 +/- 3.7 days. During follow-up, two deaths (8.7%) due to heart failure occurred. In survivors, NYHA functional class improved from 3.9 +/- 0.4 preoperatively to 2.2 +/- 0.4 at follow-up (p = 0.0037) and left ventricular ejection fraction from 0.24 +/- 0.05 to 0.30 +/- 0.05 (p = 0.0035) in patients with ischemic dilated cardiomyopathy, and from 0.23 +/- 0.04 to 0.26 +/- 0.05 (p = NS) in patients with idiopathic dilated cardiomyopathy.

Mitral surgery in advanced left ventricular dysfunction can be accomplished with an acceptable operative risk. It offers a durable functional improvement. In ischemic dilated cardiomyopathy concomitant myocardial revascularization procures a significant amelioration in the left ventricular performance as evaluated at echocardiography.