Background Data comparing outcomes after repair versus replacement of chronic ischemic mitral regurgitation (MR) is evolving. Recent data suggest that repair is associated with recurrent MR, but not survival, when compared with replacement. However, it remains unclear when either surgical strategy should be applied based on preoperative mitral valve anatomy.;Methods Between 2001 and 2013, 161 patients underwent repair or replacement of chronic ischemic MR. The mean age of these patients was 68.2 ± 9.0 years, 44 (27%) were female, and concomitant coronary artery bypass grafting was performed in 126 (78%). The mean preoperative posterior leaflet angle was 27.7 ± 14.2 degrees, and the left ventricular ejection fraction was 41.2?± 12.4%. Detailed preoperative assessments of mitral valve anatomy were determined by transesophageal echocardiography. Clinical and echocardiographic follow-up was for 4.6 ± 3.2 years and extended to 11.7 years.;Results Overall, perioperative death occurred in 6 (3.3%) patients; 2 patients died after valve repair and 4 after valve replacement. Five-year survival and freedom from recurrent MR (≥2+) rates were 74.0 ± 5.6% and 57.8 ± 8.0%, respectively, after valve repair and 69.4 ± 6.2% and 87.1 ± 7.0%, respectively, after valve replacement. Valve repair was associated with recurrent MR (≥2+) (hazard ratio [HR], 5.3 ± 3.3; p?= 0.007), but not survival (HR, 0.9 ± 0.3; p?= 0.8). Preoperative posterior leaflet tethering angle was associated with survival (HR, 1.09 ± 0.04; p?= 0.005) and also recurrent MR (≥2+) (HR, 1.04 ± 0.02; p?= 0.03) after valve repair. Based on a receiver operator curve describing the relationship between recurrent MR (≥2+) and posterior leaflet tethering angle, a threshold of 22 degrees was determined.;Conclusions Surgical correction of chronic ischemic MR can be performed with favorable early and late results, although recurrent MR occurred more often after repair. Among patients who underwent repair of ischemic MR, a preoperative posterior leaflet tethering angle of 22 degrees or greater was associated with worse late outcomes.;;Dr Ruel discloses a financial relationship with Medtronic and Edwards Lifesciences.;Jump to SectionMaterial and MethodsPatient Population and Follow-UpOperative TechniqueStatistical AnalysesResultsFavorable Early and Late Survival Was Observed for Patients Undergoing Valve Repair and ReplacementRecurrent Mitral Regurgitation Occurred More Often After Mitral Valve Repair Compared With ReplacementPosterior Leaflet Tethering Angle Was Associated With Survival and Recurrent Mitral RegurgitationThreshold Posterior Leaflet Tethering Angle of 22 Degrees or Greater Was Associated With Recurrent Mitral Regurgitation After Mitral Valve RepairCommentLimitationsConclusionsDiscussionReferences;Between 2001 and 2013, 161 patients underwent mitral valve operations for chronic severe MR at the University of Ottawa Heart Institute; valve repair was performed in 84 patients and valve replacement in 77. Postoperatively, patients were assessed in a dedicated valve clinic, where postoperative echocardiograms were routinely performed [14, 15, 16, 20]. Clinical and echocardiographic follow-up averaged 4.6 ± 3.2 years. Preoperative echocardiographic assessments were performed for all patients. Postoperatively, 228 echocardiograms were available for analysis of these 161 patients, at a mean of 3.1 ± 2.9 years?and a maximum of 10.1 years after the surgical procedures.;Patients underwent mitral valve repair through sternotomy with cardioplegic arrest. Downsizing ring annuloplasty was performed for all patients with the semirigid Medtronic Future Band (Medtronic, Minneapolis, MN) in 69 (82%) patients, the Carpentier-Edwards Physio ring (Edwards Scientific, Irvine, CA) in 7 (8%) patients, the Duran AnCore annuloplasty system (Duran, Minneapolis, MN) in 5 (6%) patients, and the Cosgrove-Edwards annuloplasty band (Edwards Scientific, Irvine, CA) in 3 (4%) patients. The average annuloplasty s
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