Mitral valve repair in severe ischemic cardiomyopathy

Background: Patients with ischemic mitral valve insufficiency (MR) and poor left ventricular (LV) function present a high operative risk. Whether to repair or replace these valves is controversial, while some suggest that heart transplant offers a better solution. We investigated our early and late results in this difficult subset of patients. Methods: Between 1993-1999, 115 patients underwent mitral valve repair (MVR) in our department. Twenty-one patients had severe LV dysfunction with ejection fraction <25%. Mean age was 60 years (range 45-81). Nineteen (90%) were in New York Heart Association (NYHA) Class IV, 7 (33%) underwent emergency surgery, 3 (14%) were in cardiogenic shock, and 2 (10%) were taken to the operating room under cardiopulmonary resuscitation. All underwent coronary artery bypass grafting (CABG) in addition to MVR, with a mean number of grafts 2.9 per patient. Results: There were no early operative deaths. The average stay in intensive care was 5.9 days (range 1-52). There were three late deaths (14%). Follow-up evaluation up to 3 years showed marked improvement in clinical status. Twelve (67%) patients are in NYHA Class I-II, and three (17%) in Class Ill. Echocardiography revealed good function of the mitral valve in all, although overall LV function did not change significantly. Conclusion: (1) MVR in patients with severe ischemic cardiomyopathy can be accomplished with excellent results. (2) There is marked symptomatic improvement in these patients, even though LV function did not seem to be improved. (3) Long-term survival still needs to be defined.