Mitral regurgitation surgery in heart failure due to ischemic cardiomyopathy: a 24-year experience.
OBJECTIVE
The long-term benefits of mitral regurgitation (MR) surgery in ischemic cardiomyopathy (ICM) are controversial. Herein are reported the results and trends of this surgical approach over the past 24-year period.


METHODS
Patients were identified in refractory heart failure due to ICM with NYHA functional class III/IV symptoms, left ventricular ejection fraction < or =35% and MR who underwent mitral surgery between 1979 and 2002. The early and late outcomes were analyzed and compared for the different surgical eras classified as early (1979 to 1986), middle (1987 to 1994), and late (1995 to 2002).


RESULTS
Mitral repair (70%) and replacement (30%) were performed with coronary artery bypass grafting (CABG) (85%) and tricuspid valve repair (7%) in 179 patients (mean age 68 +/- 9 years). The overall one- and five-year survival rates were 84% and 51%, respectively, and the corresponding freedom from recurrent MR after repair 86% and 55%. An increasing number of patients underwent surgery from the early to the late era. Whereas patients more frequently presented with cardiomegaly and renal failure during the early era, they were older, more often had prior CABG, concurrent tricuspid regurgitation and underwent mitral repair during the late era. A progressive improvement was observed in operative mortality from the early to late eras (24%, 11% and 5%, respectively; p = 0.009), and also for the one-and five-year survivals (68%, 85% and 89%; 46%, 43% and 57%, respectively; p = 0.06). Preoperative renal failure and concomitant tricuspid valve repair were predictors of late mortality.


CONCLUSIONS
During the past 24 years, operative results for the surgical correction of MR in patients with heart failure due to ICM have steadily improved. Currently, while the early and mid-term survival are satisfactory the long-term survival is limited, especially when heart failure is complicated by renal failure and severe tricuspid regurgitation.
Ngaage
Dumbor L
DL
Division of Cardiovascular Surgery, Mayo Medical Center, Rochester, Minnesota, USA. dngaage@yahoo.com
Daly
Richard C
RC
Rosales
Gabriella
G
Sundt
Thoralf M
TM
Dearani
Joseph A
JA
Mullany
Charles J
CJ
McGregor
Christopher G
CG
Orszulak
Thomas A
TA
Puga
Francisco J
FJ
Schaff
Hartzell V
HV
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome