Subscribe to RSS
DOI: 10.1055/s-2004-816694
Risk adjusted clinical outcome in ischemic mitral valve disease: Mitral valve repair versus replacement
Objectives: Ischemic mitral valve insufficiency is a predictor for high perioperative mortality and poor long time survival in cardiac surgery. It is unclear whether repair of the valve offers an advantage for patients undergoing mitral valve surgery for ischemic mitral valve regurgitation. Aim of the study was to evaluate mitral valve repair and replacement for ischemic mitral disease.
Material and Methods: We demonstrate 109 patients undergoing coronary artery bypass grafting and additional valve intervention. The EuroSCORE model was used to allow valid comparison of clinical outcome of either mitral valve reconstructed or replaced patients. Intermediate-term survival survival up to 3 years together with possible influencing factors were evaluated.
Results: Demographical characteristics of the patients and morphological structure of the valves were similar in either the repair and the replacement group, with the exception of a higher incidence of annular calcification in the replacement group. Overall perioperative mortality was 22.9% (25 patients) and was higher in the replacement group (17.6% vs. 31.7%, p=0.091). Three year survival was statistically significant better in the repair group (78.4% vs. 60.9%, p=0.042). Multivariate analysis identified age (Hazard Ratio (HR):1.064, p=0.048), impaired left ventricular function (HR: 5.688, p=0.019), acute mitral valve regurgitation (HR: 3.102, p=0.005), and mitral valve replacement (HR: 2.24, p=0.031) as independent predictors for intermediate-term survival up to 3 years.
Conclusions: Demonstrating a similar cohort of patients, survival was significantly higher in valve reconstructed patients and was an independent predictor for improved outcome. We recommend mitral valve reconstruction if the ischemic valve allows sufficient repair.