Mitral valve relpair and revascularization for ischemic mitral regurgitation: predictors of operative mortality and survival.

Ischemic mitral regurgitation (IMR) is a complication of coronary artery disease (CAD) caused by partial or complete obstruction of one or more coronary arteries (1,2). IMR may result from rupture of the papillary muscles, distortion of papillary muscle geometry, aneurysm formation or ventricular and annular dilatation, and is nearly always associated with regional or global left ventricular dysfunction (3-5). The SAVE (Survival and Ventricular Enlargement) study data demonstrated a 19.4% incidence of IMR following myocardial infarction (6). IMR occurs in approximately 3% of patients undergoing coronary angiography (7), and in 4-5% of those undergoing coronary artery bypass grafting (CABG) surgery (8). A better understanding of the pathology of IMR and mechanical function of the left ventricle may account for an increasing number of patients referred for surgical correction of IMR. Surgery for IMR may be challenging as it carries a higher operative risk than isolated myocardial revascularization or mitral valve procedures for other etiologies of mitral regurgitation. Surgical treatment options include CABG alone (9), mitral valve repair with suture annuloplasty (10-12), annuloplasty ring (8,13-15) or other mitral valve repair techniques (16,17), mitral valve replacement with preservation of part or all of the mitral apparatus (18-20) and left ventriculoplasty combined with mitral valve repair techniques (21-23). Presented at the First Biennial Meeting of the Society for Heart Valve Disease, 15th-18th June 2001, Queen Elizabeth II Conference Centre, London, United Kingdom