title: Mitral valve surgery simultaneous to coronary revascularization in patients with end-stage ischemic cardiomyopathy.
abstract: Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, predicts a poor outcome in terms of survival and morbidity. Between 1995 and 2003, 180 consecutive patients with impaired LV function and chronic ischemic MVR underwent cardiac surgery. Fifty-four patients (group I), MVR (grade III-IV) underwent simultaneous MV surgery and coronary artery bypass grafting (CABG); 40 patients (group II), MVR (grade II-III), and 86 patients (group III), MVR (grade I-II), underwent CABG alone. In group I, MV repair was performed in 36 patients (group IA) and MV replacement in 18 (group IB). The incidence of hospital death was similar between groups. The actuarial event-free survival was significantly lower in group than in groups II and III (P = 0.0045) and I (P = 0.038). The overall actuarial survival was significantly higher in group IA than in group IB (P = 0.027). Postoperatively, the LV ejection fraction (P < 0.001), LV end-diastolic diameter (P < 0.001), LV end-systolic diameter (P < 0.01), and cardiac index (P < 0.001) improved significantly in group I. The regurgitation fraction decreased significantly in Groups I and III after surgery (P < 0.001 and P = 0.003, respectively). Both MV repair and replacement that preserves subvalvular apparatus in patients with end-stage ischemic myocardiopathy offer an acceptable outcome. Mitral valve repair simultaneous to CABG improves significantly the LV function and its geometry. In patients with mild to moderate mitral regurgitation, CABG alone may be performed with good overall survival, but with lower event-free survival than those undergoing concomitant mitral valve repair.
authors.affiliation: Cattedra e Scuola di Specializzazione in Cardiochirurgia, Università degli Studi di Firenze, University Hospital of Florence Careggi, Florence, Italy. mbonacchi@unifi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.forename: Edvin
authors.initials: E
authors.lastname: Prifti
authors.forename: Massimo
authors.initials: M
authors.lastname: Maiani
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Nathan
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery; D020257:Ventricular Remodeling