Mitral valve repair in uremic congestive cardiomyopathy

BACKGROUND: There is limited reported experience on mitral valve repair in patients with chronic renal failure. This study was designed to evaluate the outcomes of mitral valve repair in patients suffering from congestive heart failure as a result of uremic cardiomyopathy and severe mitral regurgitation requiring chronic hemodialysis. METHODS: From 1995 to 2002, 5 women, ages 41 to 64 years (53 +/- 8 years), with uremic congestive cardiomyopathy and end-stage renal disease on chronic hemodialysis who underwent mitral valve repair for severe mitral regurgitation were identified retrospectively and followed for clinical and echocardiographic outcomes. The preoperative New York Heart Association functional class was 3.8 +/- 0.45. RESULTS: All patients had good results immediately after surgical mitral valve repair with no more than mild mitral regurgitation. During the follow-up at an average of 22.4 +/- 14.9 months (range, 3 to 41 months) postoperatively, all patients returned to New York Heart Association functional class I. Neither mitral calcification nor increasing peak transmitral gradient (or decreasing mitral valve orifice area) was notable by two-dimensional echocardiography. No reoperation was required. CONCLUSIONS: Although accelerated calcification of the repaired mitral valve and high incidence of failure of the reconstruction had been reported in patients with end-stage renal disease, based on our experience we advocate mitral valve repair when this can be safely performed, especially in patients with uremic congestive cardiomyopathy, in view of the added advantage of retaining the native valve in such patients.