Progression of mitral regurgitation following ischemic mitral valve repair

Abstract

Durability of mitral valve repair for ischemic mitral regurgitation remains questionable. The aim of our study was to reveal predictors of recurrent mitral regurgitation following ischemic mitral valve repair. The study population consisted of 136 patients with ischemic heart disease and ischemic mitral regurgitation. Mitral valve repair was performed at the Kaunas University of Medicine Hospital in 2000-2004. Preoperative echocardiographic examinations were performed two days before surgery, early postoperative examinations 5-10 days after mitral valve repair, late postoperative examinations at 1.89+/-0.15 years after operation. Mitral regurgitation increased from 0.78+/-0.77 at early period to 1.46+/-0.81 at late postoperative period (P<0.001). At late follow-up mitral regurgitation increased in 13 (9.5%) patients in comparison with preoperative mitral regurgitation and in 69 (50.7%) patients in comparison with early postoperative mitral regurgitation. Left ventricular end-diastolic diameter decreased significantly from 56.44+/-6.29 mm at early period to 54.44+/-5.98 mm at late period (P<0.004). Left ventricular ejection fraction increased from 35+/-10% at early period to 38+/-10% at late period (P<0.047). Left atrial diameter decreased from 46.12+/-6.35 mm at early period to 43.95+/-6.94 mm at late period (P<0.034). Multivariate analysis revealed predictors of late postoperative mitral regurgitation: preoperative left ventricular end-systolic diameter index (P=0.037), left ventricular wall motion score index (P=0.042), mitral regurgitation (P=0.013), and systolic pulmonary artery pressure (P=0.04). It is possible to predict the progression of mitral regurgitation following ischemic mitral valve repair. Late postoperative mitral regurgitation depends on these preoperative echocardiographic variables: left ventricular end-systolic diameter index, left ventricular wall motion score index, mitral regurgitation, and systolic pulmonary artery pressure.