Clinical outcomes of valve-sparing reconstructive surgery for ischemic mitral regurgitation: a 5-year single-center report and review of current global trends

The presence of ischemic mitral regurgitation (MR) is associated with increased morbidity and mortality. Following acute myocardial infarction, the incidence of ischemic MR ranges from 17 % to 55 %. The optimal choice of surgical treatment for moderate and severe mitral valve (MV) insufficiency of ischemic origin remains a controversial issue for cardiologists and cardiac surgeons, despite the recommendations of current guidelines. Aim. To enhance treatment outcomes for patients with ischemic MR by identifying the frequency and determinants of adverse postoperative events following sustained restoration of MV function over the long term. Materials and methods. A single-center retrospective observational study was conducted, analyzing clinical data from 32 consecutive patients with MV insufficiency operated on at the Zaporizhzhia Regional Clinical Hospital from 01.01.2020 to 31.12.2024. The average postoperative observation period was 14.5 ± 5.9 months (minimum – 6, maximum – 24 months). The average age of the patients was 62.3 ± 7.1 years. By gender, the studied patients were distributed as follows: women – 7 (21.88 %), men – 25 (78.12 %). Results. The mean ICU stay was 4.0 ± 2.2 days. The total length of hospital stay was 15.7 ± 4.8 days. The in-hospital mortality rate was 9.38 %. The most common cause of early mortality in the postoperative period was acute cardiovascular failure. At the time of discharge, 4 (13.8 %) patients had no residual MR. Minimal (trivial) MR was detected in 15 (51.72 %) patients, mild MR in 7 (24.14 %) patients, and moderate MR in 3 (10.35 %) patients. In the early postoperative period, there were no reoperations due to the progression of residual MR. In the long-term period, no fatalities were noted during the follow-up. Freedom from moderate and severe MR amounted to 80 % in the long-term postoperative period. Conclusions. Early surgical intervention is recommended to improve the long-term treatment results of ischemic MR. Durable restoration of mitral valve function can be achieved with low perioperative mortality and favorable long-term survival. In late stages of severe MR, replacement of the MV is recommended instead of surgical repair.