DO PATIENTS WITH LESS-THAN ECHO-PERFECT RESULTS FROM MITRAL-VALVE REPAIR BY INTRAOPERATIVE ECHOCARDIOGRAPHY HAVE A DIFFERENT OUTCOME

Background. Not all valve repairs for mitral regurgitation (MR) have a perfect result, with no MR on postpump intraoperative echocardiograph y. Although more than 2+ MR by postpump echocardiography has led to se cond pump runs for further surgery in 6% to 8% of our patients, those left with 1+ or 2+ MR, traditionally an acceptable result, have not pr eviously been evaluated for clinical outcome. Methods and Results. Amo ng 530 patients undergoing mitral repair during 1987 to 1989, 76 patie nts with 1+ or 2+ MR by postpump intraoperative echocardiography were compared with 76 patients who had equivalent age, sex, left ventricula r function, and concomitant surgery but who had no MR by postpump echo . In-hospital morbidity measured by the frequency of respiratory compl ications, strokes, time in intensive care unit, and duration of hospit al stay was actually higher in the patients with no MR after repair. H ospital mortality was not significantly different. There were no signi ficant differences in posthospital mortality (4-year survival estimate of 86% in both groups), thromboembolic events, hospitalizations for h eart failure, or functional class, although more patients in the group with no MR after repair were using diuretics. There was a trend towar d more reoperations in patients with 1+ or 2+ MR compared with those w ith no MR by intraoperative echocardiography after repair (4-year esti mates of freedom from reoperation, 83% versus 94%; adjusted risk ratio , 3.30). Conclusions. The presence of 1+ or 2+ MR by postpump intraope rative echocardiography does not confer increased morbidity or mortali ty. However, the trend toward more reoperations suggests the need for close follow-up for possible recurrence of MR. These data support our low threshold for performing further surgery during second pump runs.