Long-term results of the surgical treatment of chronic ischemic mitral regurgitation: comparison of repair and prosthetic replacement

J Heart Valve Dis. 2004 May;13(3):421-8; discussion 428-9.


Background and aim of the study: The optimal management of chronic ischemic mitral regurgitation (CIMR) remains controversial. Herein, the authors reviewed the past 10 years of their experience to compare the long-term results of mitral valve repair with prosthetic replacement.

Methods: Between January 1993 and January 2003, 102 patients (mean age 67.8 years; range: 51-80 years) with a preoperative diagnosis of CIMR, underwent mitral valve repair (n = 61; 59.8%) or prosthetic replacement (n = 41; 40.2%), along with myocardial revascularization (2.5 +/- 1.0 distal anastomoses per patients, internal thoracic artery used in 78.5%). A Carpentier Classic ring was always used in the repair procedures. The two groups were homogeneous for preoperative characteristics and comorbidities.

Results: Total operative mortality was 7.8% (repair 8.2%; prosthesis 7.3%; p = NS). The five-year actuarial survival (operative mortality included) was 66.6 +/- 7.4% for repair and 73.4 +/- 8.7% for prosthesis (p = NS). Cox multivariate analysis showed as independent risk factor for late survival a preoperative left ventricular ejection fraction (LVEF) < or = 30% (RR 3.91; 95% CI = 1.47-10.38) and a preoperative pulmonary artery pressure (PAP) > or = 35 mumHg (RR 2.74; 95% CI = 1.07-7.02), while the type of mitral procedure was not significant. Patients with annular dilation as a mechanism of regurgitation were significant more likely to undergo repair rather than receive a prosthesis. Their preoperative LVEF and PAP were significantly worse than patients who had altered leaflet motion as a regurgitation mechanism.

Conclusion: Prosthetic mitral replacement and valve repair offer very similar results for CIMR. When a perfect repair is not easily feasible, cardiac surgeons should not hesitate to perform mitral valve replacement, as it is an excellent alternative therapy, though long-term outcome is mainly dependent on preoperative condition.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery*
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / surgery*
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / mortality
  • Myocardial Ischemia / surgery*
  • Pulmonary Artery / physiopathology
  • Stroke Volume
  • Survival Rate
  • Treatment Outcome