Mitral valve repair for mitral regurgitation secondary to coronary artery disease.

Mitral regurgitation secondary to ischemic heart disease carries a significant mortality in the untreated patient. We report on 141 patients with mitral regurgitation secondary to ischemic heart disease who underwent complete coronary revascularization and correction of mitral regurgitation by either repair (101 patients) or replacement (40 patients). Good long- and short-term palliation was obtained. Left ventricular function (ejection fraction) and recent myocardial infarction were important preoperative determinants of outcome. Repair of the mitral apparatus rather than valve replacement was associated with better long- and short-term survival, especially in the patient with a low ejection fraction. The repaired valve is durable and repair minimizes the risks of thromboembolism, hemolysis, anticoagulation, and intracardiac infection associated with prosthetic valve replacement. Mitral valve repair was possible in 70% of the patients in this series. The benefit to the patient, especially the patient with compromised ventricular function, compensates the surgeon for any extra effort involved in conservation of the mitral apparatus.