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Late Results of Isolated Mitral Annuloplasty for “Functional” Ischemic Mitral Insufficiency
Author(s) -
Grossi Eugene A.,
Bizekis Costas S.,
LaPietra Angelo,
Derivaux Christopher C.,
Galloway Aubrey C.,
Ribakove Greg H.,
Culliford Alfred T.,
Esposito Rick A.,
Delianides Julie,
Colvin Stephen B.
Publication year - 2001
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2001.tb00530.x
Subject(s) - medicine , cardiology , ejection fraction , mitral regurgitation , mitral valve repair , concomitant , mitral valve annuloplasty , fibrous joint , surgery , mitral valve , heart failure
A bstractBackground: Repair of functional ischemic mitral regurgitation (MR) due to annular deformity and leaflet restriction remains a challenge for the surgeon and lacks well‐documented outcomes. We investigated outcomes in the treatment of functional ischemic MR corrected by annuloplasty techniques alone. Methods: From May 1980 to July 1999, 174 patients underwent repair for functional ischemic mitral insufficiency with annuloplasty alone (128 ring annuloplasty; 46 suture annuloplasty). Acute insufficiency was present in 25 (14.4%). Concomitant procedures included CABG (n = 152;87.4%). Patients wisro studied longitudinally with annual follow‐up and echocardiograms. Results: Overall hospital mortality was 17.8% and was increased by NYHA Class 4 (23.8% vs. 8.7%; p = 0.011), diabetes (25.0% vs. 13.6%; p = 0.059), and chronic mitral insufficiency (16.4% vs. 8.0%; p = 0.070). Multiverlatis analysis revealed age (β= 0.099; p = 0.049) and ejection fraction < 30% (β= 1.260; p = 0.097) as significant predictors of hospital death. Mean postoperative mitral insufficiency was 0.84 ± 0.86 (scale of 0–4). NYHA Class 4 (β= 2.33; p = 0.034) and simple suture annuloplasty (β= 2.08; p = 0.07) were associated with increased risk of late cardiac death. Cumulative incidence of mitral reoperation was 7.7% at 5 years. At follow‐up, 89.7% of patients were in NYHA Class 1 or 2 with 83.4% having none or only mild mitral insufficiency. Conclusions: Ring annuloplasty is associated with a survival benefit when compared to simple suture repair in ischemic patients who require annuloplasty alone to correct the MR. Mitral re construction with a ring annuloplasty offers durable results in this homogeneous subset of functional ischemic MR patients. Ischemic mitral insufficiency is associated with significant late mortality.