EARLY OUTCOME OF MITRAL-VALVE RECONSTRUCTION IN PATIENTS WITH END-STAGE CARDIOMYOPATHY

Uncontrollable severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy, significantly contributing to heart failu re in these patients, and predicts a poor survival, Although eliminati on of mitral valve regurgitation could be most beneficial in this grou p, corrective mitral valve surgery has not been routinely undertaken i n these very ill patients because of the presumed prohibitive operativ e mortality, We studied the early outcome of mitral valve reconstructi on in 16 consecutive patients with cardiomyopathy and severe, refracto ry mitral regurgitation operated on between June 1993 and April 1994, There were 11 men and five women, aged 44 to 78 years (64 +/- 8 years) with left ventricular ejection fractions of 9% to 25% (16% +/- 5%), P reoperatively all patients were in New York Heart Association class IV , had severe mitral regurgitation (graded 0 to 4+ according to color f low Doppler transesophageal echocardiography) and two were listed for transplantation. Operatively, a flexible annuloplasty ring was implant ed in all patients, Four patients also had single coronary bypass graf ting for incidental coronary disease, In four patients the operation w as performed through a right thoracotomy because of prior coronary byp ass grafting, and four patients also underwent tricuspid valve reconst ruction for severe tricuspid regurgitation, No patient required suppor t with an intraaortic balloon pump, There were no operative or hospita l deaths and mean hospital stay was 10 days, There were three late dea ths at 2, 6, and 7 months after mitral valve reconstruction, and the 1 -year actuarial survival has been 75%, At a mean follow-up of 8 months , all remaining patients are in New York Heart Association class I or II, with a mean postoperative ejection fraction of 25% +/- 10%, There have been no hospitalizations for congestive heart failure, and a decr ease in medications required has been noted, For patients with cardiom yopathy and severe mitral regurgitation, mitral valve reconstruction a s opposed to replacement can be accomplished with low operative and ea rly mortality, Although longer term follow-up is mandatory, mitral val ve reconstruction may allow new strategies for patients with end-stage cardiomyopathy and severe mitral regurgitation, yielding improvement in symptomatic status and survival.