Mitral valve reconstruction and mitral valve replacement for ischemic mitral insufficiency

Area of Science:

• Cardiology
• Cardiac Surgery
• Transplantation

Background:

• Ischemic mitral incompetence presents high operative risks for both valve repair and replacement.
• The comparative benefits of repair versus replacement in this patient group remain unclear.

Purpose of the Study:

• To evaluate the outcomes of mitral valve repair and replacement in patients with ischemic mitral insufficiency and varying degrees of left ventricular function.
• To determine the optimal surgical strategy for this patient population.

Main Methods:

• A retrospective analysis of 232 patients undergoing surgery for ischemic mitral valve insufficiency between April 1986 and December 1994.
• Comparison of operative mortality and actuarial survival rates between mitral valve replacement (98 patients) and valve reconstruction (102 patients).
• Stratification of risk based on left ventricular ejection fraction (LVEF), with specific attention to patients with LVEF 10%-30%.

Main Results:

• Overall operative mortality was 13.3% for mitral valve replacement and 14.7% for valve reconstruction.
• Patients with severely impaired left ventricular function (LVEF 10%-30%) faced significantly higher operative mortality (up to 50.0% for replacement, 42.9% for reconstruction).
• Heart transplantation was performed in 24 patients with severely impaired function, with a 12.5% operative mortality.

Conclusions:

• Valve repair or replacement carries excessive risk for patients with severely impaired left ventricular function and ischemic mitral insufficiency; cardiac transplantation should be considered.
• For patients with moderately impaired left ventricular function, valve reconstruction or replacement offers an acceptable prognosis.
• Successful mitral valve reconstruction requires reducing insufficiency to at least grade I; otherwise, valve replacement is preferred to avoid worse outcomes.