PRIMARY MITRAL REGURGITATION AND RESULTS OF SURGICAL MANAGEMENT IN A PROSPECTIVE STUDY

Abstract

Mitral regurgitation (MR) remains the second dominant defect in the structure of valvular cardiac diseases [1]. It affects more than 2 million people in the USA. Basic causes are classified as degenerative (with valve prolapse) and ischemic (due to ischemic heart disease) in advanced countries or rheumatic ones (in developing countries) [2, 3]. Alone radical method of MR treatment is surgical correction through mitral valve repair (MVRe) or replacement (MVR) yielding definitely higher survival percentage and improvement of heart failure (HF) class comparing to pharmacotherapy [4]. Evolution of approaches to the management of non-ischemic MR passed through some stages, starting from predominantly MVR to organ-preserving approaches like plastic repair [5]. In the prospective single-center study the results of treatment of 72 patients with primary MR (PMR) who were subjected to mitral valve replacement (MVR) or plastic mitral valve repair (MVRe) performed in the Department of cardiac surgery affiliated with Lviv regional clinical hospital (Ukraine) since October, 2013 till February, 2016 were analyzed. The conclusions of performed study are the following: 1) Key direct cause of MR is the chordal rupture of MV cusps, etiological factor in the majority of advanced countries is degenerative changes in contrast to rheumatic changes in the developing countries. 2) Principal method of MR surgical correction in out center is MVR, though the preferable global trend is MVRe. 3) Complications and lethality percentages in this study were higher among the patients from MVR group. Improvement of HF class according to NYHA was more evident in the MVRe group. This corresponds to results of other studies and guidelines that recommend MVRe as optional method for MR correction