Cor Vasa 2011, 53(8-9):470-480 | DOI: 10.33678/cor.2011.117

Midterm results of mitral valve repair done on patients with ischemic mitral regurgitation and nonischemic mitral regurgitation

Štefan Lukačín^1,*, František Sabol¹, Ingrid Schusterová¹, Jana Jevčáková¹, Helena Vargová¹, Marián Martinček¹, Ján Luczy¹, Martin Beňa¹, Martin Studenčan², Michal Hulman³

¹ Klinika srdcovej chirurgie

² Klinika kardiológie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika a Východoslovenský ústav srdcových a cievnych chorôb, a. s., Košice

³ Klinika srdcovej chirurgie, Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Objective: First, to compare early and midterm results of mitral valve repair in patients with ischemic mitral regurgitation (IMR) and nonischemic mitral regurgitation (NIMR). Second, to compare the incidence and effect of comorbidities on early and midterm mortality rates.

Methods: A total of 82 patients undergoing mitral valve repair was divided into two groups based on mitral regurgitation etiology. The IMR group included 51 (62.2%) patients and the NIMR group included 31 (37.8%) patients. Diabetes mellitus (DM) was present in 21 cases (41.2% - IMR group) and 4 cases (12.9% - NIMR group); chronic renal insufficiency (CRI) was present in 11 cases (21.6% - IMR) and 2 cases (6.5% - NIMR), myocardial infarction (MI) occurred in 31 cases (60.8% - IMR) and 2 cases (6.5% - NIMR), chronic obstructive pulmonary disease (COPD) occurred in 15 cases (29.4% - IMR) and 7 cases (22.6% - NIMR). Echocardiography was the basic examination method that was used. Follow-up echocardiography was performed postoperatively and after 6, 12, 18, 24, and 36 months. Patients' characteristics and outcomes were compared using univariate, multivariate (ANOVA test) and Kaplan-Meier analyses (SPSS 16.0 for Windows).

Results: IMR patients were older, had more comorbidities (p < 0.05, excepting COPD), lower ejection fraction, and lower NYHA. The Kaplan-Meier survival curve was worse in the IMR group compared to NIMR (p = 0.379). In-hospital mortality rate was 7.8% (4 of 51 patients) in the IMR group and 6.5% (2 of 31 patients) in the NIMR group. In terms of survival, the following comorbidities were important, CRI occurred in 66% of those who died compared to 12% of those who survived, DM (83.3% compared to 26.7%). IM was not statistically significant. The one-year mortality was 13% (9 patients). DM was identified as a significant predictor of early and midterm mortality (p = 0.002) as was CRI (p < 0.001). Cardiopulmonary bypass time (CPB) (p < 0.001), left ventricular endsystolic diameter (p = 0.015), and left ventricular enddiastolic diameter (p = 0.005) were also identified as statistically significant mortality predictors. Age, gradient of mitral regurgitation, NYHA, and EF had a very little effect on long-term results after surgery. The degree of mitral regurgitation between the groups in the study period was not significantly different postoperatively.

Conclusions: In spite of several comorbidities occurring in the IMR group, we can conclude that mitral valve repair has comparable results in both the IMR and NIMR groups. A comprehensive approach to IMR repair has a good and durable outcome. Long-term survival is influenced mostly by initial patient characteristics and comorbidities as an ischemic cause of mitral regurgitation per se.

Keywords: Ischemic mitral regurgitation; Nonischemic mitral regurgitation; Mitral valve repair

Published: August 1, 2011  Show citation