Results following valve replacement for ischemic mitral regurgitation.
BACKGROUND
Although several authors have favoured mitral repair in ischemic mitral regurgitation (IMR), mitral valve replacement is a valuable option and most often a necessity in patients with structural IMR.


OBJECTIVE
To review the authors' experience with valve replacement for patients with acute and chronic IMR. The effect of preserving the valve leaflets and the subvalvular apparatus during replacement was also evaluated.


METHODS
The authors' experience with mitral valve replacement for IMR between 1990 and 1999 was retrospectively analyzed at the Montreal Heart Institute, Montreal, Quebec. Results obtained with mitral valve replacement due to degenerative disease were used for comparative purposes.


RESULTS
Ninety-two patients with IMR and 213 patients with degenerative mitral regurgitation underwent valve replacement with mechanical prostheses (262 of 305 [86%]) or biological prostheses (43 of 305 [14%]). Fifteen patients (15 of 92 [16%]) died within 30 days of mitral valve replacement among IMR patients compared with eight (eight of 213 [4%)] among patients with degenerative mitral valve disease (P=0.01). The seven-year survival average following mitral valve replacement was 66+/-7% in patients with ischemic disease compared with 72+/-4% in patients with degenerative disease (P=0.07). Cardiopulmonary bypass time (odds ratio [OR] 1.01) and emergency operation (OR 2.5) were correlated with the 30-day mortality; the patient's age (OR 1.04) was the only risk factor correlated with the seven-year mortality after valve replacement. The five-year survival of patients with papillary muscle rupture averaged 59+/-12% compared with 78+/-7% in those with functional IMR.


CONCLUSIONS
Preoperative risk factors and higher early mortality in patients with mitral valve replacement for ischemic disease contribute to a lower seven-year survival than with mitral valve surgery for degenerative disease. The short and long term survival of the patients in the acute structural mitral disease subgroup was significantly worse.
Bouchard
D
D
Montreal Heart Institute and University of Montreal, Montreal, Canada.
Pellerin
M
M
Carrier
M
M
Perrault
L P
LP
Pagé
P
P
Hébert
Y
Y
Cartier
R
R
Dyrda
I
I
Pelletier
L C
LC
D000368:Aged; D003327:Coronary Disease / Q000150:complications; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies