Surgery for mitral regurgitation associated with ischemic heart disease. Results and strategies

Analysis of published reports indicates that ischemic mitral insufficiency is associated with higher operative mortality (10-30%) than is nonischemic mitral valve procedures. Probable incremental risk factors include emergency operation, acute myocardial infarction, hemodynamic instability, poor left ventricular function, pulmonary hypertension, advanced age, and renal failure. Early valve repair or replacement with myocardial revascularization improves survival in patients with circulatory insufficiency due to acute postinfarction mitral regurgitation. Although the technique of repair of nonacute ischemic mitral insufficiency is not standardized, repair with revascularization is preferred. Preliminary data suggest that long-term results are primarily related to the severity of left ventricular dysfunction.