title: Long-term results of the surgical treatment of chronic ischemic mitral regurgitation: comparison of repair and prosthetic replacement.
abstract: OBJECTIVE
  The optimal management of chronic ischemic mitral regurgitation (CIMR) remains controversial. Herein, the authors reviewed the past 10 years of their experience to compare the long-term results of mitral valve repair with prosthetic replacement.
  
  
  METHODS
  Between January 1993 and January 2003, 102 patients (mean age 67.8 years; range: 51-80 years) with a preoperative diagnosis of CIMR, underwent mitral valve repair (n = 61; 59.8%) or prosthetic replacement (n = 41; 40.2%), along with myocardial revascularization (2.5 +/- 1.0 distal anastomoses per patients, internal thoracic artery used in 78.5%). A Carpentier Classic ring was always used in the repair procedures. The two groups were homogeneous for preoperative characteristics and comorbidities.
  
  
  RESULTS
  Total operative mortality was 7.8% (repair 8.2%; prosthesis 7.3%; p = NS). The five-year actuarial survival (operative mortality included) was 66.6 +/- 7.4% for repair and 73.4 +/- 8.7% for prosthesis (p = NS). Cox multivariate analysis showed as independent risk factor for late survival a preoperative left ventricular ejection fraction (LVEF) < or = 30% (RR 3.91; 95% CI = 1.47-10.38) and a preoperative pulmonary artery pressure (PAP) > or = 35 mumHg (RR 2.74; 95% CI = 1.07-7.02), while the type of mitral procedure was not significant. Patients with annular dilation as a mechanism of regurgitation were significant more likely to undergo repair rather than receive a prosthesis. Their preoperative LVEF and PAP were significantly worse than patients who had altered leaflet motion as a regurgitation mechanism.
  
  
  CONCLUSIONS
  Prosthetic mitral replacement and valve repair offer very similar results for CIMR. When a perfect repair is not easily feasible, cardiac surgeons should not hesitate to perform mitral valve replacement, as it is an excellent alternative therapy, though long-term outcome is mainly dependent on preoperative condition.
authors.affiliation: Department of Cardiac Surgery, University of Insubria, Ospedale di Circolo e Fondazioni Macchi, Viale Borri 57, 21100 Varese, Italy. vitmantovani@hotmail.com
authors.forename: Vittorio
authors.initials: V
authors.lastname: Mantovani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Cristian
authors.initials: C
authors.lastname: Leva
authors.forename: Claudio
authors.initials: C
authors.lastname: Blanzola
authors.forename: Paolo
authors.initials: P
authors.lastname: Cattaneo
authors.forename: Andrea
authors.initials: A
authors.lastname: Sala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011651:Pulmonary Artery / Q000503:physiopathology; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome