Mitral valve repair for ischemic mitral insufficiency.

Area of Science:

• Cardiology
• Cardiac Surgery
• Heart Valve Disease

Background:

• Ischemic mitral insufficiency is an uncommon cause of mitral valve disease.
• Mitral valve disease affects native valves, with ischemia identified as the cause in 6.5% of cases over a 5-year period.
• Patient demographics included a mean age of 66 years, with 53.8% being women.

Purpose of the Study:

• To evaluate the outcomes of surgical repair for ischemic mitral insufficiency.
• To assess the efficacy of various surgical techniques in restoring mitral valve competence.
• To compare survival rates based on the underlying mechanism of mitral insufficiency (prolapse vs. restrictive leaflet motion).

Main Methods:

• Retrospective analysis of 1,292 patients undergoing native mitral valve operations over 5 years.
• Identification of 84 patients with ischemia-induced mitral insufficiency.
• Surgical repair techniques included leaflet resection, chordal shortening, papillary muscle reimplantation/shortening, and annuloplasty, often combined with myocardial revascularization.

Main Results:

• Mitral valve repair was performed in 77.4% of patients with ischemic mitral insufficiency.
• Hospital mortality was 9.2%, with no significant difference between acute (9.1%) and chronic (9.3%) onset.
• Postoperative mitral insufficiency was significantly reduced (0.6 +/- 0.8).
• At mean follow-up of 3.1 years, survival was 96% for valve prolapse and 48% for restrictive leaflet motion (p=0.02).
• New York Heart Association functional class improved across all groups.

Conclusions:

• Ischemic mitral insufficiency is a treatable condition amenable to surgical repair in most cases.
• Surgical intervention is associated with low operative mortality and improved long-term survival, particularly in patients with valve prolapse.
• Repair techniques effectively restore valve competence and improve functional status.