title: Results of surgery for irreversible moderate to severe mitral valve regurgitation secondary to myocardial infarction.
abstract: OBJECTIVE
  Moderate to severe irreversible mitral regurgitation secondary to myocardial infarction is an independent risk factor for reduced long-term survival. Late effects of correction of mitral incompetence concomitant with coronary artery bypass grafting (CABG) are less well known and the choice of mitral valve procedure is still debated.
  
  
  METHODS
  From 1988 to 1998, 93 consecutive patients (mean age 63+/-9 years) were treated for moderate to severe irreversible mitral regurgitation secondary to myocardial infarction; 84 were in NYHA functional class III-IV and 19 were in cardiogenic shock. Thirty-seven patients underwent emergency surgery. Perioperative intraaortic balloon pump (IABP) was necessary in 33 patients. Follow-up ranged from 6 months to 12 years (mean 51 months+/-41).
  
  
  RESULTS
  Mitral valve was repaired in 30 patients and replaced in 63. Replacement was preferably performed in patients with major displacement of papillary muscle and in patients with acute papillary muscle rupture. CABG (3.4 distal anastomoses) was performed in all patients and was complete in 92%. Early mortality was 15% (14/93). Multivariable analysis identified need for IABP (P=0.005) and COPD (P=0.02) as risk factors for early death. Emergency surgery had only a trend (P=0.15) for increased mortality; age, low ejection fraction, repair vs. replacement had no influence. Actuarial survival rates at 1, 5 and 10 years were 81, 65 and 56%, respectively. Late survival was similar in patients with replacement or repair (P=0.46). At last follow-up, all but one patient were in NYHA functional class I or II.
  
  
  CONCLUSIONS
  Combined mitral valve procedure and myocardial revascularization, as complete as possible, for moderate to severe mitral regurgitation secondary to myocardial infarction achieve satisfactory early and late outcome despite the increased operative mortality. Acute papillary muscle rupture, severe restriction of the mitral valve by major displacement of the papillary muscle are better managed by valve replacement.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland. reza.tavakoli@triemli.stzh.ch
authors.forename: Reza
authors.initials: R
authors.lastname: Tavakoli
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Brunner-La Rocca
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Paul
authors.initials: P
authors.lastname: Vogt
authors.forename: Rene
authors.initials: R
authors.lastname: Pretre
authors.forename: Rolf
authors.initials: R
authors.lastname: Jenni
authors.forename: Marko
authors.initials: M
authors.lastname: Turina
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000145:classification / Q000209:etiology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome