Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization.
OBJECTIVE
Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, is predictive of poor outcome. The study aim was to assess the feasibility of mitral valve surgery concomitant with coronary artery bypass grafting (CABG) in patients with ischemic MVR grade II-III and impaired LV function.


METHODS
Between January 1996 and July 2000, 99 patients with grade II and III ischemic MVR and LV ejection fraction (LVEF) 17-30% underwent either combined mitral valve surgery and CABG (group I, n = 49) or isolated CABG (group II, n = 50). LVEF (%), LV end-diastolic diameter (LVEDD; mm), LV end-diastolic pressure (LVEDP; mmHg), LV end-systolic diameter (LVESD; mm) respectively were 27.5+/-5, 67.7+/-7, 27.7+/-4 and 51.4+/-7 in group I versus 27.8+/-4, 67.5+/-6, 27.5+/-5 and 51.2+/-6 in group II. In group I, mitral valve repair was performed in 43 patients (88%) and replacement in six (12%).


RESULTS
Preoperative data analysis showed no difference between groups. Five patients (10%) died in group I, compared with six (12%) in group II (p = NS). Within six months of surgery, LV function and geometry improved significantly in group I versus group II (LVEF, p <0.001; LVEDD, p = 0.002; LVESD, p = 0.003, LVEDP, p <0.001); only mild improvements were seen in group II. The regurgitation fraction decreased significantly in group I patients after surgery (p <0.001). Cardiac index increased significantly in groups I and II (p <0.001 and p = 0.03, respectively). In group I at follow up, four of six patients undergoing mitral valve replacement died, compared with five of 43 patients (11.5%) undergoing mitral valve repair (p = 0.007). At three years, the overall survival in group II was significantly lower than in group I (p <0.009).


CONCLUSIONS
Both MV repair and replacement preserving subvalvular apparatus in patients with impaired LV function offered acceptable outcome in terms of morbidity and survival. Surgical correction of grade II-III MVR in patients with impaired LV function should be taken into consideration as it provides better survival and improves LV function.
Prifti
E
E
Department of Cardiac Surgery, Policlinico Careggi, Firenze, Italy.
Bonacchi
M
M
Frati
G
G
Giunti
G
G
Babatasi
G
G
Sani
G
G
D000206:Actuarial Analysis; D000368:Aged; D001026:Coronary Artery Bypass; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000601:surgery*