Ischemic mitral regurgitation: To repair or replace? A single center experience

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Valvular Heart Disease

Background:

• Ischemic mitral regurgitation (MR) management remains complex.
• Surgical strategies, including mitral valve repair (MVr) and replacement (MVR), are debated.
• Previous reports suggest MVR may offer better hemodynamic performance than MVr.

Purpose of the Study:

• To compare the outcomes of MVr versus MVR in patients with ischemic MR.
• To evaluate hemodynamic mitral valve performance at 1 and 2 years postoperatively.
• To assess survival differences between MVr and MVR groups.

Main Methods:

• A single-center cardiac surgery database was queried for patients (aged ≥18 years) undergoing mitral valve surgery with concomitant CABG or PCI.
• Patients were divided into two groups: MVr (ring annuloplasty) and MVR.
• Data on demographics, operative variables, and postoperative outcomes were analyzed.

Main Results:

• 111 patients (44% MVr, 56% MVR) were included; both groups had high rates of concomitant CABG.
• MVr group had lower ejection fraction (EF) preoperatively but shorter bypass and cross-clamp times.
• In-hospital and 1-year mortality were similar; 2-year mitral regurgitation severity was comparable between groups.

Conclusions:

• Mitral valve repair and replacement demonstrate similar early mortality and mid-term hemodynamic performance in ischemic MR.
• MVr is a potentially suitable surgical option for patients with ischemic MR requiring surgical revascularization.
• Further research may explore long-term outcomes and patient selection criteria.