[Surgical treatment of coronary disease with ischemic mitral regurgitation--early and late results].
Patients with ischemic mitral incompetence have a high operative risk and the advantage of repair over replacement in those patients is unclear. In cases of moderate mitral regurgitation and coronary artery disease operative strategy continues to be debated between coronary artery bypass grafting (CABG) alone and concomitant valve replacement or repair. The objective of the study is to review our experience with the different surgical treatments and to assess the impact of pre- and intraoperative factors on mortality, morbidity and long-term survival.


METHODS
From July 1990 to May 2000, 102 patients with ischemic mitral regurgitation > 2 + grade underwent operative treatment. CABG alone was performed in 52 and combined procedures in 50 cases (18 replacements and 32 repairs). Mitral repairs were accomplished by Carpentier or Key techniques and/or ring implantation. All replacements were done with preservation of the posterior mitral valve leaflet.


RESULTS
Overall mortality is 11(10.8%)-3 patients (5.8%) in the CABG group and 8 (16%) in the combined group (3-16.7% for replacement and 5-15.6% for repair). There was 7 late deaths in both groups. Five year survival was 78% for CABG, 78% for repair and 76 for replacement.


CONCLUSIONS
In high risk patients with ejection fraction < 35% and mitral regurgitation < 3 + grade we recommend CABG alone. Valve replacement is the procedure of choice in case of papillary muscle rupture. All patients need complete revascularisation. Good results are obtained with repair techniques and ring implantation.
Baev
B
B
Iliev
R
R
Gadeva
S
S
Nachev
S
S
Chirkov
A
A
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate