Mitral valve surgery in the patient with left ventricular dysfunction.

Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 125 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred twenty-five patients with 4+ MR, left ventricular ejection fractions from 8% to 24% (mean 14%), and New York Heart Association class III or IV symptoms were prospectively studied. All patients underwent mitral valve repair with an undersized flexible annuloplasty ring. There was one intraoperative death and five 30-day mortalities. Intraoperative echocardiography showed mild to trivial MR in seven patients, and no residual MR in the majority of patients. There were 26 late deaths; three of these patients had progression of the disease and underwent transplantation. One- and 2-year actuarial survival has been 80% and 70%, respectively. New York Heart Association class has improved for all the patients from a preoperative mean of 3.2 +/- 0.2 to 1.8 +/- 0.4 postoperatively. At 24-month follow-up, all patients showed an improvement of ejection fraction, cardiac output, and end-diastolic volumes, along with a reduction in sphericity index and regurgitant volume. Mitral valve repair with an undersized flexible annuloplasty ring is a safe and effective approach to correct MR in cardiomyopathy patients. All observed changes contribute to reverse remodeling and the restoration of the normal left ventricular geometric relationship. Mitral reconstruction offers a new treatment strategy for patients with MR and end-stage heart failure.