title: A change in perspective: results for ischemic mitral valve repair are similar to mitral valve repair for degenerative disease.
abstract: BACKGROUND
  Although the benefits of mitral valve repair for degenerative disease are well established, many consider surgery for functional ischemic mitral regurgitation (MR) less amenable to operative treatment. We hypothesized that mitral valve repair for ischemic MR results in outcomes similar to those for mitral valve repair for degenerative MR.
  
  
  METHODS
  Retrospective review of nonemergent mitral valve repairs for an 8-year period revealed 105 patients with functional ischemic MR, of whom 39 were treated for severe tethering (ischemic group), and 245 patients with degenerative MR (degenerative group).
  
  
  RESULTS
  Patients in the ischemic group had more comorbidities (p < 0.01) and worse preoperative left ventricular dysfunction (ejection fraction < or = 0.29) compared with patients in the degenerative group; (ischemic, 37.1% [39 of 105] versus degenerative, 2.0% [5 of 245]; p < 0.01). Immediate postrepair transesophageal echocardiogram revealed a 0 to 1+ MR in all patients in both groups (not significant). The hospital mortality rate was 1.9% (2 of 105) in the ischemic group and 1.2% (3 of 245) in the degenerative group (p = 1.00). The 5-year survival rate was 83.9% in the ischemic group and 94.3% in the degenerative group (p < 0.01). Five-year freedom from reoperation for recurrent MR was 100% and 97.5% in the ischemic and degenerative groups, respectively (p = 0.14). Postoperative renal failure and stroke rates were similar between both groups (not significant). The incidence of moderate or greater MR after more than 1 year of follow-up was similar between groups (not significant).
  
  
  CONCLUSIONS
  Despite the multiple comorbidities that afflict patients with ischemic MR, mitral valve repair for ischemic and degenerative disease produces comparable and satisfactory outcomes. An aggressive approach to repair of functional ischemic MR, including treatment of tethering, leads to durable results.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. lmg2x@virginia.edu
authors.forename: Leo M
authors.initials: LM
authors.lastname: Gazoni
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Brian R
authors.initials: BR
authors.lastname: Swenson
authors.forename: John M
authors.initials: JM
authors.lastname: Dent
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Mulloy
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Fedoruk
authors.forename: Turner C
authors.initials: TC
authors.lastname: Lisle
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome