[Surgery for mitral valve insufficiency].
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.
Zalaquett
Ricardo
R
Departamento de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile. rzalaque@med.puc.cl
Garrido
Luis
L
Morán
Sergio
S
Irarrázaval
Manuel J
MJ
Becker
Pedro
P
Maturana
Gustavo
G
Chamorro
Gastón
G
Braun
Sandra
S
Godoy
Iván
I
Córdova
Samuel
S
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