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(Circulation. 2009;120:S104-S111.)
© 2009 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mitral Repair versus Replacement for Ischemic Mitral Regurgitation

Comparison of Short-Term and Long-Term Survival

Julien Magne, PhD; Nicolas Girerd, MD; Mario Sénéchal, MD; Patrick Mathieu, MD; François Dagenais, MD; Jean G. Dumesnil, MD; Éric Charbonneau, MD; Pierre Voisine, MD; Philippe Pibarot, DVM, PhD, FAHA

From Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada.

Correspondence to Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, Quebec, Canada, G1V-4G5. E-mail philippe.pibarot{at}med.ulaval.ca

Background— When compared to mitral valve replacement (MVR), mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR). However, there is an important controversy about the type of surgical treatment that should be used in patients with ischemic MR. The objective of this study was to compare the postoperative outcome of MVRp versus MVR in patients with ischemic MR.

Methods and Results— Preoperative and operative data of 370 patients with ischemic MR who underwent mitral valve surgery were prospectively collected and retrospectively analyzed. MVRp was performed in 50% of patients (n=186) and MVR in 50% (n=184). Although operative mortality was significantly lower after MVRp compared to MVR (9.7% versus 17.4%; P=0.03), overall 6-year survival was not statistically different between procedures (73±4% versus 67±4%; P=0.17). After adjusting for other risk factors and propensity score, the type of procedure (MVRp versus MVR) did not come out as an independent predictor of either operative (OR, 1.5; 95% CI, 0.7–2.9; P=0.34) or overall mortality (HR, 1.2; 95% CI, 0.7–1.9; P=0.52).

Conclusion— As opposed to what has been reported in patients with organic MR, the results of this study suggest that MVRp is not superior to MVR with regard to operative and overall mortality in patients with ischemic MR. These findings provide support for the realization of a randomized trial comparing these 2 treatment modalities.

Key Words: ischemia • mitral valve • prosthesis • regurgitation • valves

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