Echocardiographically based treatment of chronic ischemic mitral regurgitation

Objectives: We evaluated results of an echocardiographically based strategy combining mitral annuloplasty with other procedures to treat chronic ischemic mitral regurgitation. Methods: From March 2006 to February 2009, 147 patients underwent mitral valve surgery for chronic ischemic mitral regurgitation. Mean effective regurgitant orifice was 36 +/- 11 mm(2), and ejection fraction was 35% +/- 9%. On the basis of echocardiographic findings, in 10 cases a prosthesis was inserted and mitral annuloplasty was performed in 137 cases, isolated in 83, associated with chordal cutting in 12 cases (in 5 anterior leaflet was augmented with pericardial patch), and with exclusion of anteroseptal (n = 35) or inferior (n = 7) scars in 42. Results: Thirty-day mortality was 4.8%; 3-year survival was 86% +/- 3%. None of the 126 survivors were in New York Heart Association functional class III or IV. Among 117 survivors of mitral valve repair, after 18 +/- 6 months mean effective regurgitant orifice reduced from 34.1 +/- 10.2 mm(2) to 2.3 +/- 0.4 mm(2) (P < .001). Nine patients showed residual effective regurgitant orifice 10 to 19 mm(2). Reverse remodeling was present in 69 patients (59.0%), no remodeling in 40 (34.1%), and continuous remodeling in 8 (6.9%). Ejection fraction changed from 37% +/- 10% to 43% +/- 10% (P <.001), improving in 47, remaining unchanged in 63, and worsening in 7. Conclusions: Echocardiographically based strategy contributed to reduced postoperative mitral regurgitation persistence (effective regurgitant orifice >= 10 mm(2) in 7.7% of cases, with no patients showing effective regurgitant orifice >= 20 mm(2)). All patients remained in New York Heart Association functional class I or II, but more than mitral annuloplasty was performed in close to 40%. (J Thorac Cardiovasc Surg 2011;141:1150-6)