Mitral Valve Reconstruction and Replacement for Ischemic Mitral Insufficiency: Seven Years' Follow Up Harald Hausmann MD, Henrik Siniawski MD, Roland Hetzer MD Between April 1986 and December 1998, 337 patients underwent surgery for ischemic mitral valve insufficiency. Coronary artery bypass grafting (CABG) was carried out concomitantly in 314 cases (93.2%). Valve repair was performed in 140 patients (operative mortality rate 12.1%). The surgical risk in patients with a left ventricular ejection fraction (LVEF) of 10-30% was higher (mortality rate 33.3%) than in those with LVEF >30% (mortality rate 8.4%); actuarial survival was 75.4%, 66.8% and 61.7% after 2, 5 and 7 years, respectively. Mitral valve replacement was performed in 197 patients (operative mortality rate 14.2%). The surgical risk in patients with a LVEF of 10-30% (mortality rate 30.3%) was greater than in those with a LVEF of >30% (mortality rate 11.0%); actuarial survival was 78.6%, 73.4% 67.2% after 2, 5 and 7 years, respectively. After mitral valve repair, mortality during follow up was greater in patients with residual mitral valve insufficiency of more than grade I. Operative outcome was superior when repair was evaluated perioperatively with transesophageal echocardiography. Patients with highly impaired LV function and ischemic mitral insufficiency are at high risk during valve repair or replacement, and cardiac transplantation should be considered. However, patients with ischemic mitral insufficiency and moderately impaired LV function can undergo valve repair or replacement with an acceptable prognosis.

536