PMID- 10327320
OWN - NLM
STAT- MEDLINE
DCOM- 19990609
LR  - 20061115
IS  - 0046-5968 (Print)
IS  - 0046-5968 (Linking)
VI  - 29
IP  - 4
DP  - 1999 Apr
TI  - [The surgical treatment of chronic ischemic mitral insufficiency].
PG  - 418-23
AB  - BACKGROUND: Operative correction of chronic ischemic mitral regurgitation (CIMR) 
      is associated with a high-risk approach. The objective of this retrospective 
      study was to evaluate the short- and long-term results of surgical treatment of 
      CIMR. METHODS: From 1989 to 1997, mitral valve replacement or repair was 
      performed on 46 patients with CIMR. The average age range was 63.7 +/- 6.9; 8 
      patients were females; 30 patients (65.2%) were in New York Heart Association 
      (NYHA) functional class III or IV; 4 patients (8.6%) were in chronic atrial 
      fibrillation and preoperative myocardial infarction was lower in 23 patients 
      (50%). Preoperative echo-Doppler analysis showed severe mitral insufficiency in 
      15 patients (32.6%). Preoperative mean pulmonary artery pressure (PAP) was 33.6 
      +/- 13.6 mmHg, mean ejection fraction (EF) 37.8 +/- 13.5%. Mitral valve 
      replacement was performed in 12 patients (26%). Mitral valve repair was performed 
      in 34 patients (73.9%). Myocardial revascularization was performed in 42 patients 
      (91.3%) (mean graft/patient 2.2 +/- 0.8); aneurysmectomy was performed in 5 
      patients (10.8%), and in 2 patients (4.3%) tricuspid insufficiency was corrected 
      by performing annuloplasty. RESULTS: The overall operative mortality was 8.6% (4 
      patients). The operative mortality for repair was 5.8% (2 patients) and for 
      replacement was 16.6% (2 patients). One patient was reoperated three days after 
      first operation due to annuloplasty dehiscence. Postoperative morbidity included 
      low output syndrome in 7 patients (15.2%), bleeding in 2 patients (4.3%), and 
      cerebral embolism in 2 patients (4.3%). The mean length of stay in intensive care 
      was 6.5 +/- 10.5 days. Follow-up (mean 27.6 +/- 3.3 months) was 88% complete and 
      revealed good functional and clinical results: 86.4% of the patients in I-II NYHA 
      class. One patient was reoperated due to mitral insufficiency progression. Two 
      late deaths occurred, one due to acute myocardial infarction and the other to 
      lung cancer. CONCLUSION: While long-term follow-up is mandatory, our results 
      suggest that: a) surgical treatment of CIMI is feasible with acceptable operative 
      risks; b) mid-term functional and clinical results are favorable; c) the choice 
      of treatment--valve replacement or repair--is still debatable.
FAU - Scrofani, R
AU  - Scrofani R
AD  - Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale L. Sacco, Milano.
FAU - Cialfi, A
AU  - Cialfi A
FAU - Ravagnan, S
AU  - Ravagnan S
FAU - Fundaro, P
AU  - Fundaro P
LA  - ita
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
TT  - Il trattamento chirurgico dell'insufficienza mitralica ischemica cronica.
PL  - Italy
TA  - G Ital Cardiol
JT  - Giornale italiano di cardiologia
JID - 1270331
SB  - IM
MH  - Aged
MH  - Coronary Artery Bypass
MH  - Extracorporeal Circulation
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/diagnosis/mortality/*surgery
MH  - Myocardial Ischemia/diagnosis/mortality/*surgery
MH  - Postoperative Complications/epidemiology
MH  - Retrospective Studies
EDAT- 1999/05/18 00:00
MHDA- 1999/05/18 00:01
CRDT- 1999/05/18 00:00
PHST- 1999/05/18 00:00 [pubmed]
PHST- 1999/05/18 00:01 [medline]
PHST- 1999/05/18 00:00 [entrez]
PST - ppublish
SO  - G Ital Cardiol. 1999 Apr;29(4):418-23.