Thorac Cardiovasc Surg 2005; 53 - MP52
DOI: 10.1055/s-2005-862032

Mitral valve repair for ischemic mitral regurgitation: Impact of pathomechanism on left ventricular remodelling and outcome

L Duebener 1, E Kraatz 1, C Geisbuesch 1, M Petersen 1, M Misfeld 1, U Stierle 1, H Sievers 1
  • 1Universitätsklinikum SH, Campus Lübeck, Abt. für Herzchirurgie, Lübeck

Objectives: Ischemic mitral regurgitation (IMR) is secondary to myocardial ischemia or myocardial infarction. Little information exists if left ventricular (LV) remodeling and outcome of these patient groups differ after mitral valve plasty (MVP) and coronary artery bypass grafting (CABG).

Material and Methods: Between January 1995 and December 2003, 106 patients underwent MVP and CABG for IMR in our institution. IMR was due to myocardial infarction in 66 patients (group INF) and secondary to myocardial ischemia in 40 patients (group ISCH). The two groups (INF vs. ISCH) were not significantly different regarding mean age (65.8±8.9 vs. 65.5±9.2 years), preoperative NYHA class (2.9±0.7 vs. 3.0±0.7), LV ejection fraction (44.4±14.2% vs. 44.7±15.8%), LV enddiastolic diameter (60.6±7.0 vs. 61.3±8.2mm) and severity of MR (2.9±0.9 vs. 3.0±0.6). All patients underwent mitral annuloplasty and CABG (2.4±1.1grafts per patient). Echocardiographic information regarding valvular and ventricular function was obtained pre- and postoperatively. Mean follow-up was 38±13 months.

Results: In-hospital mortality was not significantly different between the groups: INF 9.1% (6/66) vs. ISCH 10.0% (4/40). Late mortality was higher in the INF group (12 deaths) relative to the ISCH group (2 deaths). Actuarial 5-year survival was significantly higher in the ISCH group (85.0±8.2% (ISCH) vs. 72.7±8.9% (INF), p<0.001). Postoperative LVEDD decreased significantly in both groups (ISCH 55.4±10.2mm, INF 56.9±7.2mm). Risk factors for late mortality were preoperative EF, LVEDD and NYHA class.

Conclusions: In our experience surgery for IMR was associated with significant early mortality in both groups. Operative treatment of IMR resulted in a significant decrease of LVEDD in both groups. Late survival was significantly poorer in patients with preoperative myocardial infarction compared to patients with myocardial ischemia.