Unlike degenerative mitral insufficiency, ischemic failure is due to an increase in the left ventricular cavity, the loss of its elliptical form, ring dilation and displacement of the papillary muscles leading to the loss of coaptation the leaflets. European and American guidelines suggest the intervention on the mitral valve in patients with ischemic mitral regurgitation who will undergo coronary artery bypass graft surgery (CABG). However it is not clear whether plastic or changes it. We included 251 patients with severe ischemic mitral regurgitation randomized to plastic valve or mitral valve replacement with CABG. The primary endpoint was the left ventricular reverse degree remodeling assessed by end-systolic volume. At year’s end systolic volume was similar between both groups (54.6 ± 25 ml/m2 for plastic group versus 60.7 ± 31.5 ml/m2 for the valve replacement group, P = .18). The recurrence rate of mitral regurgitation at one year was significantly higher in the plastic group (32.6 versus 2.3%, p <0.001).
Conclusion:
Valve replacement in ischemic mitral regurgitation provides longer lasting effects than plastic mitral valve repair with no differences in the left ventricular reverse degree remodeling or patients clinically.
Michael Acker.
2013-11-18
Original title: Severe Ischemic Mitral Regurgitation: Is it Better to Repair or Replace the Valve.
