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 mm2, 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 mm2 to 2.3 ± 0.4 mm2 (P < .001). Nine patients showed residual effective regurgitant orifice 10 to 19 mm2. 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 mm2 in 7.7% of cases, with no patients showing effective regurgitant orifice ≥20 mm2). All patients remained in New York Heart Association functional class I or II, but more than mitral annuloplasty was performed in close to 40%. Copyright © 2011 by The American Association for Thoracic Surgery.