PMID- 10767792
OWN - NLM
STAT- MEDLINE
DCOM- 20000607
LR  - 20190514
IS  - 0003-4932 (Print)
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 231
IP  - 5
DP  - 2000 May
TI  - Does the additive risk of mitral valve repair in patients with ischemic 
      cardiomyopathy prohibit surgical intervention?
PG  - 710-4
AB  - OBJECTIVE: To assess the surgical risk of additional mitral valve repairs in 
      patients with ischemic cardiomyopathy. SUMMARY BACKGROUND DATA: Severe mitral 
      regurgitation in patients with ischemic cardiomyopathy increases the death rate 
      and symptomatic status. The 1-year survival rate for medical therapy in this 
      subset of patients is less than 20%. Transplantation is usually not feasible 
      because of donor shortage and death while on the waiting list. METHODS: To assess 
      additive risk, a retrospective chart review from 1993 to 1998 was performed 
      comparing patients with ischemic cardiomyopathy (ejection fraction [EF] <25%) and 
      severe mitral regurgitation undergoing mitral valve repair and coronary artery 
      bypass graft operations with patients with an EF of <25% undergoing coronary 
      artery bypass graft alone. These groups were also compared with 140 patients 
      receiving heart transplants since 1993 (group 3). RESULTS: The overall hospital 
      death rate for group 1 was 6.3%. The one death occurred 2 weeks after surgery 
      secondary to sepsis. This was not significantly different from the death rate of 
      4.1% in group 2. In group 1, there were two deaths at 1 year (87% survival rate), 
      one related to heart failure. One patient was New York Heart Association (NYHA) 
      class IV at 1 year; the remainder of patients were NYHA class I-II. These results 
      were not significantly different than the 8% death rate noted with 
      transplantation. There was no change in EF and minimal residual mitral 
      regurgitation in group 1 based on postoperative transesophageal echocardiography, 
      whereas group 2 had an average 11.7% improvement in EF. CONCLUSIONS: Previously, 
      severe mitral regurgitation in the setting of ischemic cardiomyopathy has been 
      associated with poor survival. In these authors' experience, repairing the mitral 
      valve along with coronary artery bypass grafting does not increase the surgical 
      risk, yields improvement in symptomatic status, and compares favorably to 
      coronary artery bypass grafting alone and cardiac transplantation. However, the 
      lack of change in EF in these patients probably represents an overestimation of 
      the EF before surgery secondary to severe mitral regurgitation.
FAU - Gangemi, J J
AU  - Gangemi JJ
AD  - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, 
      University of Virginia Health Sciences Center, Charlottesville, Virginia 22903, 
      USA. jjg5d@virginia.edu
FAU - Tribble, C G
AU  - Tribble CG
FAU - Ross, S D
AU  - Ross SD
FAU - McPherson, J A
AU  - McPherson JA
FAU - Kern, J A
AU  - Kern JA
FAU - Kron, I L
AU  - Kron IL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Cardiomyopathy, Dilated/complications/*surgery
MH  - Case-Control Studies
MH  - Coronary Artery Bypass
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/complications/*surgery
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stroke Volume
PMC - PMC1421058
EDAT- 2000/04/18 09:00
MHDA- 2000/06/10 09:00
PMCR- 2000/11/01
CRDT- 2000/04/18 09:00
PHST- 2000/04/18 09:00 [pubmed]
PHST- 2000/06/10 09:00 [medline]
PHST- 2000/04/18 09:00 [entrez]
PHST- 2000/11/01 00:00 [pmc-release]
AID - 0000658-200005000-00011 [pii]
AID - 10.1097/00000658-200005000-00011 [doi]
PST - ppublish
SO  - Ann Surg. 2000 May;231(5):710-4. doi: 10.1097/00000658-200005000-00011.