Mitral Valve Replacement Is a Viable Alternative to Mitral Valve Repair for Ischemic Mitral Regurgitation: A Case-Matched Study

作者：Chan Vincent; Ruel Marc^*; Mesana Thierry G

来源：Annals of Thoracic Surgery, 2011, 92(4): 1358-1365.

DOI：10.1016/j.athoracsur.2011.05.056

Background. Comparisons of mitral valve repair with mitral valve replacement for ischemic mitral regurgitation (IMR) have been limited by differences in preoperative and operative characteristics of patients undergoing these two types of surgical treatment. We performed a propensity-based, case-matched analysis to examine whether patients who undergo mitral valve repair and those who undergo mitral valve replacement for IMR have similar long-term outcomes.
Methods. We compared 65 patients who underwent mitral valve replacement for IMR between 2001 and 2010 with 65 patients who underwent mitral repair during the same period on the basis of age, concomitant coronary bypass grafting, gender, left ventricular function, preoperative pulmonary hypertension, and urgency of operation. Mitral replacement involved preservation of the subvalvular apparatus. The mean study follow-up period was 2.5 +/- 2.1 years.
Results. Two patients who underwent mitral valve repair died at 30 days postoperatively and three patients died after valve replacement. Late survival was the same in the two groups (p = 0.4). Recurrent mitral regurgitation (MR) (grade 2+ or higher) at late follow-up was observed in 15 patients (23%) after repair; however, only 1 patient (2%) had MR with a grade of more than 2+. Mitral valve repair was more commonly associated with recurrent MR (grade 2+ or higher) than was mitral valve replacement (p = 0.04). Patients in both groups had similar freedom from valve-related complications and similar left ventricular function at follow-up (both p > 0.2).
Conclusions. Mitral valve replacement remains a viable option for the treatment of IMR. Although mitral valve repair effectively protects against persistent or recurrent moderate-to-severe MR, mitral valve replacement provides better freedom from mild-to-moderate MR in this population, with a low incidence of valve-related complications. Notably, there was no significant difference in left ventricular function between the valve-repair and valve-replacement groups at follow-up.

• 出版日期2011-10