title: Mitral replacement or repair for functional mitral regurgitation in dilated and ischemic cardiomyopathy: is it really the same?
abstract: BACKGROUND
  This was a study to compare the results of mitral valve (MV) repair and MV replacement for the treatment of functional mitral regurgitation (MR) in advanced dilated and ischemic cardiomyopathy (DCM).
  
  
  METHODS
  One-hundred and thirty-two patients with severe functional MR and systolic dysfunction (mean ejection fraction 0.32 ± 0.078) underwent mitral surgery in the same time frame. The decision to replace rather than repair the MV was taken when 1 or more echocardiographic predictors of repair failure were identified at the preoperative echocardiogram. Eighty-five patients (64.4%) received MV repair and 47 patients (35.6%) received MV replacement. Preoperative characteristics were comparable between the 2 groups. Only ejection fraction was significantly lower in the MV repair group (0.308 ± 0.077 vs 0.336 ± 0.076, p = 0.04).
  
  
  RESULTS
  Hospital mortality was 2.3% for MV repair and 12.5% for MV replacement (p = 0.03). Actuarial survival at 2.5 years was 92 ± 3.2% for MV repair and 73 ± 7.9% for MV replacement (p = 0.02). At a mean follow-up of 2.3 years (median, 1.6 years), in the MV repair group LVEF significantly increased (from 0.308 ± 0.077 to 0.382 ± 0.095, p < 0.0001) and LV dimensions significantly decreased (p = 0.0001). On the other hand, in the MV replacement group LVEF did not significantly change (from 0.336 ± 0.076 to 0.31 ± 0.11, p = 0.56) and the reduction of LV dimensions was not significant. Mitral valve replacement was identified as the only predictor of hospital (odds ratio, 6; 95% confidence interval, 1.1 to 31; p = 0.03) and overall mortality (hazard ratio, 3.1; 95% confidence interval, 1.1 to 8.9; p = 0.02).
  
  
  CONCLUSIONS
  In patients with advanced dilated and ischemic cardiomyopathy and severe functional MR, MV replacement is associated with higher in-hospital and late mortality compared with MV repair. Therefore, mitral repair should be preferred whenever possible in this clinical setting.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. michele.debonis@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: David
authors.initials: D
authors.lastname: Ferrara
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Calabrese
authors.forename: Alessandro
authors.initials: A
authors.lastname: Verzini
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery*; D012189:Retrospective Studies; D016277:Ventricular Function, Left