Results of surgery for irreversible moderate to severe mitral valve regurgitation secondary to XXXX .

@entity1 @entity339 @entity1030 @entity583 @entity1455 @entity121 @entity204
OBJECTIVE: Moderate to severe irreversible @entity339 secondary to @entity583 is an independent risk factor for reduced long-term survival. Late effects of correction of @entity339 concomitant with coronary artery bypass grafting (CABG) are less well known and the choice of mitral valve procedure is still debated. METHODS: From 1988 to 1998, 93 consecutive @entity1 (mean age 63+/-9 years) were treated for moderate to severe irreversible @entity339 secondary to @entity583 ; 84 were in NYHA functional class III-IV and 19 were in @entity1455 . Thirty-seven @entity1 underwent emergency surgery. Perioperative intraaortic balloon pump (IABP) was necessary in 33 @entity1 . Follow-up ranged from 6 months to 12 years (mean 51 months+/-41). RESULTS: Mitral valve was repaired in 30 @entity1 and replaced in 63. Replacement was preferably performed in @entity1 with major displacement of papillary muscle and in @entity1 with acute @entity121 . CABG (3.4 distal anastomoses) was performed in all @entity1 and was complete in 92%. Early mortality was 15% (14/93). Multivariable analysis identified need for IABP (P=0.005) and @entity1030 (P=0.02) as risk factors for @entity204 . Emergency surgery had only a trend (P=0.15) for increased mortality; age, low ejection fraction, repair vs. replacement had no influence. Actuarial survival rates at 1, 5 and 10 years were 81, 65 and 56%, respectively. Late survival was similar in @entity1 with replacement or repair (P=0.46). At last follow-up, all but one @entity1 were in NYHA functional class I or II. CONCLUSIONS: Combined mitral valve procedure and myocardial revascularization, as complete as possible, for moderate to severe @entity339 secondary to @entity583 achieve satisfactory early and late outcome despite the increased operative mortality. Acute @entity121 , severe restriction of the mitral valve by major displacement of the papillary muscle are better managed by valve replacement.
