Repair versus Replacement by Prosthetic Valve in Ischemic Mitral Patients

Background/Aims: Ischemic mitral regurgitation (IMR) is a complex disorder that arises from left ventricular remodeling due to coronary artery disease.The optimal surgical approach-mitral valve repair (MVRp) versus mitral valve replacement (MVR)-remains a subject of debate, with outcomes influenced by durability, recurrence risk, and left ventricular function.This work aims to compare the short-and long-term outcomes of MVRp versus MVR in patients undergoing concomitant coronary artery bypass grafting (CABG) for moderate-to-severe IMR.Materials and methods: This retrospective, non-randomized study analyzed 254 patients who underwent concomitant CABG and MV surgery for moderate-to-severe IMR between January 2013 and December 2018.Patients were divided into two groups: MVRp (n=128) and MVR (n=126).Perioperative characteristics, postoperative outcomes, and long-term survival were assessed.Results: Baseline characteristics were comparable between groups, except for a higher incidence of preoperative atrial fibrillation in the replacement group (11.9% vs. 4.7%, P=0.037).ICU stay was shorter in the replacement group (73.4863.8 vs. 84.659.59hours, P=0.048), but mechanical ventilation duration was longer (20.545.46 vs. 18.5520.1 hours, P=0.016).In-hospital mortality was similar (MVRp: 11.7% vs. MVR: 12.7%, P=0.812).Long-term mortality was 21.1% in the MVRp group and 17.5% in the MVR group.Both groups showed significant improvements in ejection fraction (MVRp: 47.6713.00%to 57.2813.34%,P=0.001; MVR: 47.2812.01%to 56.5012.27%,P=0.001) and NYHA class postoperatively.Conclusion: Both MVRp and MVR significantly improved functional status and ejection fraction, with no significant difference in long-term survival.MVRp remains susceptible to recurrent regurgitation, while MVR eliminates MR but prolongs ventilation time.Surgical choice should be tailored to patient-specific factors.