Mitral valve reconstruction and replacement for moderate to severe ischemic mitral regurgitation： comparison of midterm outcome and complications

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation（ IMR）, and report the mid-term outcome. Methods From June 2002 to May 2008, 83 patients with moderate IMR（35 eases） and severe IMR （48 cases） underwent coronary artery bypass grafting（CABG） combined with mitral valvuloplasty （MVP） （ n = 43 ） or mitral valve replacement （MVR） （ n = 40）. There were 49 males and 34 females with a mean age of （59.3 ±7.5 ） years（51 -77years）. The procedures of MVP included annuloplasty with a Dacron or autologous pericardium ring in 21cases, eommissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received bioprostheses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR （P 〉 0. 05）. The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP （ P 〈 0.05 ）. Seventy-six patients were followed by outpatient department visit or telephone for （ 20.2 ± 4, 9 ） months （ 3 - 60 months ）. During the follow-up period, 7 patients with MVP had mild insufficiency but free off other complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR . Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR. Key words: Mitral valve insufficiency Myocardial ischemia Coronary artery bypass