ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
MITRAL VALVULAR SURGERY IN ISCHEMIC MITRAL REGURGITATION
Aşkın Ali Korkmaz, Ali Rıza Karacı, Barış Çaynak, Kerem Oral, Burak Tamtekin
Kadir Has Üniversitesi Tıp Fakültesi, Florence Nightingale Hastanesi, Kalp Damar Cerrahisi Kliniği, İstanbul
Background: Presence of mitral insufficiency in the ischemic heart disease worsens the prognosis and increases the operative mortality. In this study we evaluated the results of ischemic valvular surgery and tried to explain how the preoperative risk factors effected these results.

Methods: Between March 1997 and May 2002, 109 patient underwent mitral valve replacement (MVR) (n = 82) and mitral valve plasty (MVP) (n = 27) operations because of ischemic mitral insufficiency by the same surgeon. All of these patients underwent coronary artery bypass grafting (CABG) operations at the same time. Mechanical valves used in 73 patients, bioprosthesis used in 9 patients, posterior leaflet was preserved in 48 patients, anterior and posterior leaflets were preserved in 23 patients in MVR group. Ring annuloplasty technique used in 8 and Reed annuloplasty used in19 patients in MVP group. Ten patients underwent left ventricular aneurysmectomy (LVA), 6 patients underwent tricuspid plasty operations with the mitral valvuler surgery and CABG. Preoperative risk factors, mitral insufficiency grade, pre-postopertive functional classifications, aortic cross clamping and cardiopulmonary bypass times, intensive care and hospital stays were evaluated.

Results: Two patients (20%) undergone LVA operations, 3 patients (3%) without LVA died within 30 days in the early postoperative period (total mortality 4.6%). Late mortality was seen in 6 patients (5.5%). Incidence of diabetes mellitus, chronic obstructive pulmonary disease and chronic renal disease is higher in the mortality group. Significant increase in functional class was evaluated in the first year control.

Conclusions: We conclude that the operations of mitral valve with the CABG are reliable and long term results are good. We showed the most important criteria that can effect the short and long term mortality and morbidity were the presence of left ventricular aneurysm and preoperativ risk factors.

Keywords : Ischemic mitral insufficiency, preoperativ risk factors, mitral plasty, mitral valve replacement, coronary bypass
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