A prospective study of predicting factors in ischemic mitral regurgitation recurrence after ring annuloplasty.

Background: Ischemic mitral regurgitation (IMR) is a complex lesion to repair, and its successful management requires an understanding of its mechanism and severity. Ring annuloplasty, currently the surgical treatment of choice for IMR, has failure rates as high as 30% in patients with functional IMR. We sought to study the variables that can predict IMR recurrence after ring annuloplasty.

Methods: This is a prospective study of 114 patients with 3+ to 4+ IMR who underwent coronary artery bypass grafting and mitral valve annuloplasty with acceptable results at an approximately 2-year follow-up. Variables were compared in a failure group, comprising patients with 2+ or higher MR and a nonfailure group, consisting of those with less than +2 MR.

Results: There were five postoperative in-hospital deaths. During follow-up, 14 patients died and 95 patients were evaluated. After a mean follow-up of 22.2 +/- 4.6 months for the nonfailure group and 18.6 +/- 5.6 months for the failure group, 23 patients (24.4%) exhibited annuloplasty failure. Some variables had an effect in our univariate analysis, but only interpapillary muscle distance had a relationship with recurrent MR in the multivariate analysis. Mean preoperative interpapillary muscle distance was 15.0 +/- 4.0 and 26.5 +/- 2.9 in the nonfailure group and failure group, respectively (p < 0.0001).

Conclusions: Interpapillary muscle distance, as a reliable index of dysfunctional subvalvular apparatus in patients with IMR, can predict late postrepair MR and indicate the need for a procedure complementary to annuloplasty.