Long-Term Results of the Surgical Treatment of Chronic Ischemic Mitral Regurgitation: Comparison of Repair and Prosthetic Replacement

Vittorio Mantovani, Giovanni Mariscalco, Cristian Leva, Claudio Blanzola, Paolo Cattaneo, Andrea Sala
Department of Cardiac Surgery, University of Insubria, Ospedale di Circolo e Fondazioni Macchi, Varese, Italy
 

Background and aim of the study: The optimal management of chronic ischemic mitral regurgitation (CIMR) remains controversial. Herein, the authors reviewed the past 10 years of their experience to compare the long-term results of mitral valve repair with prosthetic replacement.
Methods: Between January 1993 and January 2003, 102 patients (mean age 67.8 years; range: 51-80 years) with a preoperative diagnosis of CIMR, underwent mitral valve repair (n = 61; 59.8%) or prosthetic replacement (n = 41; 40.2%), along with myocardial revascularization (2.5 ± 1.0 distal anastomoses per patients, internal thoracic artery used in 78.5%). A Carpentier Classic ring was always used in the repair procedures. The two groups were homogeneous for preoperative characteristics and comorbidities.
Results: Total operative mortality was 7.8% (repair 8.2%; prosthesis 7.3%; p = NS). The five-year actuarial survival (operative mortality included) was 66.6 ± 7.4% for repair and 73.4 ± 8.7% for prosthesis (p = NS). Cox multivariate analysis

showed as independent risk factor for late survival a preoperative left ventricular ejection fraction (LVEF) £30% (RR 3.91; 95% CI = 1.47-10.38) and a preoperative pulmonary artery pressure (PAP) ≥35 mmHg (RR 2.74; 95% CI = 1.07-7.02), while the type of mitral procedure was not significant. Patients with annular dilation as a mechanism of regurgitation were significantly more likely to undergo repair rather than receive a prosthesis. Their preoperative LVEF and PAP were significantly worse than patients who had altered leaflet motion as a regurgitation mechanism.
Conclusion: Prosthetic mitral replacement and valve repair offer very similar results for CIMR. When a perfect repair is not easily feasible, cardiac surgeons should not hesitate to perform mitral valve replacement, as it is an excellent alternative therapy, though long-term outcome is mainly dependent on preoperative condition.
The Journal of Heart Valve Disease 2004;13:421-429
 
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