Ischemic mitral regurgitation: To repair or replace? A single center experience

PLoS One. 2024 Oct 24;19(10):e0307449. doi: 10.1371/journal.pone.0307449. eCollection 2024.

Abstract

Objective: Recent reports on ischemic mitral valve (MV) regurgitation surgical strategies have suggested better hemodynamic performance with MV replacement (MVR) than MV repair (MVr) with no survival difference at 2 years. We evaluated the difference between MVR and MVr outcomes in patients with ischemic MR, including hemodynamic MV performance at 1 and 2 years postoperatively.

Methods: A single center cardiac surgery database was queried for patients (aged >/ = 18 years) requiring mitral valve surgery with concomitant CABG or PCI between January 2010 and June 2018. Patients were separated into two groups: mitral valve repair using ring annuloplasty (MVr) and mitral valve replacement (MVR).

Results: A total of 111 patients (median age 66 years, 76% male) underwent an operation for ischemic mitral regurgitation during the study period. (44%) had MVr and 62 (56%) had MVR. Both groups had > 80% concomitant CABG. The MVr group had lower EF (40% vs. 55%, p < 0.01), shorter cardiopulmonary bypass time (117 vs. 164 minutes, p < .01) and shorter aortic cross-clamp time (80 vs. 116 minutes, p < .01). The in-hospital mortality (6% vs. 10%, p = 1.00) and 1-year mortality (14% vs. 18%, p = 0.17) were similar between the groups. Pre-operative left ventricular internal diameter at end-diastole was greater in the MVr group (5.6cm vs. 4.6cm, p < .01). At 1-year, more patients in the MVR group had no or trace regurgitation (29% vs. 61%, p = 0.01), however, the number of patients with moderate or greater mitral regurgitation was similar (6% vs. 12%, p = 0.69). At 2-years, the MVr and MVR groups had no difference in moderate or severe mitral regurgitation (7% vs. 13%, p = 0.68).

Conclusion: Our findings demonstrate similar early mortality and mid-term mitral valve performance, suggesting that MV repair could be a good surgical option in patients with ischemic MR requiring surgical revascularization.

MeSH terms

  • Aged
  • Coronary Artery Bypass / methods
  • Female
  • Heart Valve Prosthesis Implantation
  • Hemodynamics
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Annuloplasty
  • Mitral Valve Insufficiency* / mortality
  • Mitral Valve Insufficiency* / physiopathology
  • Mitral Valve Insufficiency* / surgery
  • Mitral Valve* / surgery
  • Myocardial Ischemia* / complications
  • Myocardial Ischemia* / mortality
  • Myocardial Ischemia* / physiopathology
  • Myocardial Ischemia* / surgery
  • Retrospective Studies
  • Treatment Outcome

Grants and funding

The author(s) received no specific funding for this work.