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The Annals of Thoracic Surgery, Vol 52, 1246-1251, Copyright © 1991 by The Society of Thoracic Surgeons
WG Hendren, JJ Nemec, BW Lytle, FD Loop, PC Taylor, RW Stewart and DM Cosgrove 3d
Over a 5-year period, 1,292 patients had operation on their native mitral
valves. Ischemia was the cause of mitral insufficiency in 84 patients
(6.5%). Sixty-five patients (77.4%) had mitral valve repair. Mean age was
66 +/- 10 years; 35 patients (53.8%) were women. Mean degree of
preoperative insufficiency was 3.2 +/- 0.7; mean preoperative New York
Heart Association functional class was 3.3 +/- 0.7. Eleven patients (16.9%)
had acute and 54 (83.1%) had chronic mitral insufficiency. Valve prolapse
was present in 26 patients (40%). Restrictive leaflet motion secondary to
regional or global left ventricular dilatation occurred in 39 patients
(60%). All patients had associated myocardial revascularization followed by
transatrial valvuloplasty. Multiple techniques were employed to achieve
valve competence: leaflet resection (3), chordal shortening (15), papillary
muscle reimplantation (10), papillary muscle shortening (3), and
annuloplasty (63). There were six (9.2%) hospital deaths (acute, 9.1%;
chronic, 9.3% [not significant]; prolapse, 11.5%; restrictive, 7.7% [not
significant]). The mean degree of postoperative mitral insufficiency was
0.6 +/- 0.8 in 51 patients. At a mean follow-up of 3.1 +/- 1.6 years,
patient survival was 96% for patients with valve prolapse and 48% for those
with restrictive leaflet motion (p = 0.02). New York Heart Association
functional class was improved in all groups. Ischemic mitral insufficiency
is an uncommon cause of mitral valve disease that is amenable to repair in
the majority of cases of both acute and chronic onset. The operative
mortality is low, and operation is associated with superior survival in
patients with valve prolapse.
ARTICLES
Mitral valve repair for ischemic mitral insufficiency
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195-5066.
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