Results following valve replacement for ischemic mitral regurgitation
D Bouchard, M Pellerin, M Carrier, LP Perault, P Page, Y Hebert, R Cartier, I Dyrda, LC Pelletier
BACKGROUND: Although
several authors have favoured mitral repair in ischemic
mitral regurgitation (IMR), mitral valve replacement
is a valuable option and most often a necessity in patients
with structural IMR.
OBJECTIVE:
To review the authors' experience with valve replacement
for patients with acute and chronic IMR. The effect
of preserving the valve leaflets and the subvalvular
apparatus during replacement was also evaluated.
PATIENTS
AND METHODS: The authors' experience with mitral
valve replacement for IMR between 1990 and 1999 was
retrospectively analyzed at the Montreal Heart Institute,
Montreal, Quebec. Results obtained with mitral valve
replacement due to degenerative disease were used for
comparative purposes.
RESULTS:
Ninety-two patients with IMR and 213 patients with degenerative
mitral regurgitation underwent valve replacement with
mechanical prostheses (262 of 305 [86%]) or biological
prostheses (43 of 305 [14%]). Fifteen patients (15 of
92 [16%]) died within 30 days of mitral valve replacement
among IMR patients compared with eight (eight of 213
[4%)] among patients with degenerative mitral valve
disease (P=0.01). The seven-year survival average following
mitral valve replacement was 66±7% in patients with
ischemic disease compared with 72±4% in patients with
degenerative disease (P=0.07). Cardiopulmonary bypass
time (odds ratio [OR] 1.01) and emergency operation
(OR 2.5) were correlated with the 30-day mortality;
the patient's age (OR 1.04) was the only risk factor
correlated with the seven-year mortality after valve
replacement. The five-year survival of patients with
papillary muscle rupture averaged 59±12% compared with
78±7% in those with functional IMR.
CONCLUSIONS:
Preoperative risk factors and higher early mortality
in patients with mitral valve replacement for ischemic
disease contribute to a lower seven-year survival than
with mitral valve surgery for degenerative disease.
The short and long term survival of the patients in
the acute structural mitral disease subgroup was significantly
worse.
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