Moderate ischemic mitral regurgitation and coronary artery bypass surgery: effect of mitral repair on clinical outcome.

摘要

BACKGROUND AND AIM OF THE STUDY: The optimal management of moderate (grade 2-3+) ischemic mitral regurgitation (MR) at the time of coronary artery bypass grafting (CABG) remains the subject of controversy. The study aim was to determine whether mitral repair associated with CABG is preferable to CABG alone in patients with moderate ischemic MR, in terms of intermediate outcome. METHODS: Among 60 patients with moderate ischemic MR, 30 who underwent CABG plus mitral repair were compared with 30 others who underwent CABG alone. All patients underwent follow up echocardiographic and clinical examinations between 12 and 36 months after surgery. The decision to repair the valve during surgery was totally at the surgeons' discretion. RESULTS: Preoperatively, both groups were substantially homogeneous. Patients who had CABG plus mitral repair had a lower NYHA functional class at intermediate follow up, and fewer signs and symptoms of heart failure. On multivariate analysis, mitral repair proved to be a protective factor for the development of heart failure. The preoperative size of the mitral annulus was seen to be a risk factor for subsequent heart failure events. At intermediate follow up, echocardiographic parameters were significantly better in the mitral repair group (left ventricular volume smaller, ejection fraction and pulmonary artery pressure improved). CONCLUSION: The results of this case-control study showed that, in a homogeneous series of patients with moderate ischemic MR, repair of the mitral valve at the time of CABG leads to a better clinical status due to an improved hemodynamic profile.