Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling.
OBJECTIVE
The aim of the present study was to evaluate the impact of left ventricular (LV) diastolic filling impairment on postoperative results in patients with low LV ejection fraction (EF) undergoing combined coronary artery bypass grafting (CABG) and mitral valve (MV) repair.


RESULTS
Study population consisted of 53 patients with ischemic MV incompetence and LV systolic dysfunction (mean EF-26.1 +/- 6%), who underwent CABG with MV repair. Patients were divided into three groups according to the LV diastolic filling pattern. Study protocol included evaluation of perioperative mortality (30 days inhospital mortality), NYHA functional class, and two-dimensional Doppler echocardiographic examination preoperatively, 10-14 days, and 12 months after surgery. The highest perioperative mortality rate (33.3%), unimproved functional status (in 78.5% of the patients, NYHA functional class remained unchanged late after surgery), and hemodynamic deterioration (LV dilatation, progression of mitral regurgitation (MR) was observed in the restriction group). Though early after surgery, MR reduction was significant in this group, at even one year after surgery 85.7% of patients presented with >grade 1 of MR (P < 0.05). Logistic regression analysis showed that restrictive LV diastolic filling is an important independent preoperative marker (P = 0.035) of progression of MR late after MV repair.


CONCLUSIONS
In patients with severe LV dysfunction undergoing combined CABG and MV repair, restrictive LV diastolic filling pattern is an important preoperative marker of high perioperative mortality rate, further negative remodeling of LV, and progression of mitral regurgitation late after MV repair.
Ereminiene
Egle
E
Institute of Cardiology, Heart Center and Cardiology Clinic of the Kaunas University of Medicine, Kaunas, Lithuania. eglerem@yahoo.com
Vaskelyte
Jolanta
J
Benetis
Rimantas
R
Stoskute
Neris
N
D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications / Q000503:physiopathology; D002306:Cardiac Volume / Q000502:physiology; D001026:Coronary Artery Bypass; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology