title: [Surgery for mitral valve insufficiency].
abstract: BACKGROUND
  Ischemic mitral regurgitation (IMR) is a severe condition which may be best treated by surgery, notwithstanding a relatively high mortality rate.
  
  
  OBJECTIVE
  To evaluate the results of mitral valve replacement or repair in patients with IMR.
  
  
  METHODS
  Retrospective review of the clinical records in 29 patients with IMR who were surgically treated from 1990 to 1999. They represent 8% of surgical procedures on the mitral valve.
  
  
  RESULTS
  Mean age was 67 +/- 9 years. Surgery was performed urgently in 19 patients (66.5%). NYHA functional class was 3.4 +/- 0.8. The mechanism of IMR was annular dilatation and spreading of papillary muscles in 18 patients, papillary muscle rupture in 9 and fibrosis in 2. Mitral valve replacement was performed in 14 patients and mitral valve repair in 15. Twenty four patients (83%) had concomitant myocardial revascularization. Overall surgical mortality was 24%; 26% for mitral replacement and 13% for mitral valve repair (p = 0.215). On follow up of 26 +/- 33 months, one year survival was 76 +/- 0.8% and 5 years survival was 59 +/- 12%. Excluding in hospital mortality, survival was 100% at one year and 78 +/- 14% at 5 years. Functional class improved in all survivors, to 1.4 +/- 0.5. Late echocardiographic evaluation of patients with mitral valve repair showed absence of mitral regurgitation in 58%, 1+ MR in 17% and 2+ MR in 25%.
  
  
  CONCLUSIONS
  In spite of a high perioperative mortality, surgery for IMR is a valuable procedure for patients with an otherwise highly lethal disease.
authors.affiliation: Departamento de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile. rzalaque@med.puc.cl
authors.forename: Ricardo
authors.initials: R
authors.lastname: Zalaquett
authors.forename: Luis
authors.initials: L
authors.lastname: Garrido
authors.forename: Sergio
authors.initials: S
authors.lastname: Morán
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Irarrázaval
authors.forename: Pedro
authors.initials: P
authors.lastname: Becker
authors.forename: Gustavo
authors.initials: G
authors.lastname: Maturana
authors.forename: Gastón
authors.initials: G
authors.lastname: Chamorro
authors.forename: Sandra
authors.initials: S
authors.lastname: Braun
authors.forename: Iván
authors.initials: I
authors.lastname: Godoy
authors.forename: Samuel
authors.initials: S
authors.lastname: Córdova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002677:Chile / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies