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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 165-177, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JS Rankin, MP Feneley, MS Hickey, LH Muhlbaier, AS Wechsler, RD Floyd, JG Reves, TN Skelton, RM Califf and JE Lowe
Severe mitral regurgitation caused by acute myocardial infarction has been
a particularly difficult management problem with disappointing clinical
results. Over a 75-month period, ending March 31, 1987, 611 patients
underwent mitral valve operations at Duke University Medical Center. Within
this group, 55 patients had clearly defined ischemic mitral regurgitation,
and 37 of these required emergency operations. Thirty-one of the 55
patients had isolated posterior papillary muscle dysfunction, nine had
papillary muscle rupture, and 15 had severe ventricular dysfunction and
generalized annular dilatation. Thirty-two patients were treated with
primary mitral valve replacement, and 23 had mitral valve repair. In 18,
repair was accomplished by a transventricular approach, combining the
techniques of commissural annuloplasty, papillary muscle shortening or
reimplantation, and infarct exclusion. Transventricular mitral valve repair
proved to be safe, expeditious, and effective in restoring valve
competence. Although the repair and replacement groups were similar with
respect to all relevant baseline characteristics, improved operative
survival was observed after valve repair, as compared to replacement, both
for the overall group (p = 0.03) and for acute papillary muscle dysfunction
(p = 0.05). These data suggest that a policy of predominant mitral valve
repair, when appropriately applied in patients with ischemic mitral
regurgitation, offers the potential for improving therapeutic results.
ARTICLES
A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
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