Mitral Valve Repair for Ischemic Mitral Regurgitation (original) (raw)
Ischemic mitral regurgitation (IMR) is a common complication after acute myocardial infarction due to annulus dilatation and papillary muscles displacement. In our opinion 3/4 and 4/4 IMR have always to be indicated for MV surgery. In presence of low EF and dilated LV, moderate (2/4) IMR has to be corrected. The end-systolic distance between the coaptation point of mitral leaflets and the plane of mitral valve annulus is the key point to decide repair (F10 mm) or replacement ()10 mm). MV annuloplasty has always been addressed to the posterior annulus, whose size can be easily reduced. A specially designed 40 mm long ring has been used to achieve a posterior overreductive annuloplasty. For MV repair thirty-day mortality was 2.4%. Five-year survival and the possibility of being alive and in NYHA class I-II were 75.6"4.7 and 59.8"5.4, respectively. After a mean of 38"35 months, the NYHA class decreases from 3.2"0.5 to 2.1"0.6 (P-0.001). Most patients (77.4%) have an improvement of its own functional class. MR decreases from 3.2"0.8 to 1.2"1.1 (P-0.001). 97.5% of the survivors have MR equal to or less than moderate.
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