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J Thorac Cardiovasc Surg 2007;134:1548-1553
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation

Marisa Di Donato, MDa,*, Serenella Castelvecchio, MDb, Jelena Brankovic, MDb, Carlo Santambrogio, MDb, Vincenzo Montericcio, MDb, Lorenzo Menicanti, MDb

a Department of Critical Care Medicine, University of Florence, Florence, Italy
b Department of Cardiac Surgery, San Donato Hospital, Milan, Italy.

Received for publication May 17, 2007; revisions received July 30, 2007; accepted for publication August 16, 2007.

* Address for reprints: Marisa Di Donato, MD, Department of Cardiac Surgery, San Donato Hospital, Via Morandi 30, 20097 San Donato Milanese (Milan), Italy. (Email: marad{at}tin.it).

Objective: Any grade of ischemic mitral regurgitation is associated with excess mortality. Whether mild ischemic mitral regurgitation should be repaired at the time of either coronary artery bypass grafting or surgical ventricular restoration is controversial. Surgical ventricular restoration is a treatment option for dilated post-infarction cardiomyopathy and has the potential to improve mitral functioning. The present study assessed the effectiveness of surgical ventricular restoration and unrepaired mild ischemic mitral regurgitation on left ventricular geometry, cardiac and functional status, and survival.

Methods: We analyzed 55 patients with previous anterior infarction (age 65 ± 10 years) and mild chronic functional mitral regurgitation who underwent surgical ventricular restoration and coronary artery bypass grafting without mitral repair at our center. Left ventricular volumes, ejection fraction, and geometric parameters were measured before and after surgery.

Results: Even mild ischemic mitral regurgitation is characterized by abnormal left ventricular geometry when compared with that of patients without mitral regurgitation at comparable ventricular volumes and ejection fraction. Surgical ventricular restoration induces a significant decrease in left ventricular volumes, left ventricular diameters, and papillary muscle distance; and an improvement in ejection fraction and New York Heart Association class. Ischemic mitral regurgitation significantly decreases in the majority of patients. Survival is 93% at 1 year and 88% at 3 years.

Conclusion: Surgical ventricular restoration improves mitral functioning by improving geometry abnormalities. Survival is optimal and greater than would be expected in patients with post-infarction dilated ventricles and depressed left ventricular function. Our data indicate that mitral repair in conjunction with surgical ventricular restoration is unnecessary in such patients.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; EF = ejection fraction; ERO = effective regurgitant orifice; IMR = ischemic mitral regurgitation; LV = left ventricular; MR = mitral regurgitation; SVR = surgical ventricular restoration




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