The outcome and criteria for mitral valve surgery in patients with ischemic mitral regurgitation.

OBJECTIVES

Mitral valve surgery for the correction of mitral regurgitation (MR) in patients with ischemic heart disease has been associated with poor prognosis. The criteria for selecting an appropriate surgical procedure are not clearly defined. The objectives of this study were to clarify the criteria for mitral valve manipulation and the outcome in patients with ischemic MR.

METHODS

Twenty patients with ischemic MR were proposed for surgery. Ten of them (group A) had grade II MR and underwent isolated coronary artery bypass grafting (CABG). The remaining 10 patients with grade III or more MR underwent both CABG and mitral valve repair (group B). Postoperative left ventricular function and outcome were compared.

RESULTS

Preoperative left ventricular end-systolic volume index (LVESVI) in group A was significantly smaller, while preoperative ejection fraction (EF) was almost equal between the groups. EF demonstrated a significant improvement in group A postoperatively, but no changes in group B. Two of group B died following surgery. The other patients were successfully treated with surgery which diminished MR. Congestive heart failure (CHF) developed in 2 patients of group B during follow-up and in none of group A. The 5-year freedom from CHF and the 5-year survival rate in group A were significantly greater than those in group B.

CONCLUSIONS

Deterioration of mitral valve function, which necessitated mitral valve repair, was more frequent in the impaired and enlarged hearts. Although mitral repair was beneficial for diminishing MR and New York Heart Association, postoperative course in patients with ischemic MR depended on the preoperative LVESVI.