Abstract 1808: Impact of Unrepaired Ischemic Mitral Regurgitation on Long Term Survival Following Surgical Ventricular Restoration
Background. Ischemic mitral regurgitation (MR), even if mild or moderate, is associated with poor survival . There are no guidelines regarding the necessity of repairing moderate mitral valve during ventricular restoration (SVR) for ischemic cardiomyopathy. Aim.We aimed to assess long term survival in pts with unrepaired mitral regurgitation who underwent SVR and associate CABG . Patients.286 pts undergoing SVR had some degree of mitral regurgitation which was not repaired. Mean age was 62±10 years; 56% were in NYHA class III/IV; the great majority had mild to moderate MR as evaluated by echocardiogram, 17 pts had moderate to severe MR; 56% had pre-op EF=/<35%. Indication for surgery was heart failure, angina or a combination of the two. SVR was performed on arrested heart with antegrade crystalloid or blood cold cardioplegia; CABG was performed in all pts. Follow-up was completed in 92% (263/286). A group of 102 pts (66±8 yrs) without pre-operative MR was used for survival comparison.
Results: operative cardiac mortality was 2.8% (8/286). The degree of MR was 1.4±0.7 pre-operatively, 0.8±0.7 one week after surgery (p 0.0001). NYHA functional class improved from 2.6±0.9 to 1.5±0.7 late after surgery; EF improved from 34±9 to 40±10% one week after and remained stable at late FUP (40±9%, p 0.0001). Survival curve in the overall population (any cause mortality) compared with pts without pre-op MR and survival by pre-op degree of MR are shown in Fig 1⇓.
Conclusions. Survival is excellent in the series of pts with ischemic cardiomyopathy and ischemic mitral regurgitation. Unrepaired any grade MR does not impact survival following SVR.