[Surgical strategy for mitral regurgitation in ischemic cardiomyopathy].

Surgical strategy for the mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) still remains controversial. The purpose of this study is to evaluate the operative outcome and long-term survival in patients with ICM, MR. Perioperative data and surgical results of 35 patients with ischemic MR were collected. Mitral annuloplasty with artificial ring (MAP) was performed in 27 patients and mitral valve replacement (MVR) in 8 patients. Preoperative left ventricular ejection fraction (LVEF) in MVR was significantly lower (23.1 +/- 11.8 : 33.4 +/- 10.3%, p < 0.05) and the left ventricular diastolic dimension (LVDd) was dilated (73.7 +/- 9.3: 64.2 +/- 7.0 mm, p < 0.01). Concomitant procedures including coronary artery bypass grafting and/or left ventricular reconstruction were performed in more than half patients. No operative death was observed in both groups. Postoperative data showed that MVR still remained in low left ventricular (LV) function. Six of 27 patients in MAP developed more than grade 2 MR during follow up period and 1 required reoperation. No significant difference was observed in survival and in freedom rate from cardiac event between groups. MAP had no impact on operative outcome and long-term survival in patients with ICM, MR. MVR should be considered in patients with severely impaired LV function to avoid the risk of recurrence of MR.