title: Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass.
abstract: OBJECTIVE
  The aim of this study was to explore the predictors of improvement of moderate ischemic mitral regurgitation after off-pump coronary artery bypass grafting.
  
  
  METHODS
  A prospective study was performed among 109 patients (aged 66.6 ± 8.6 years, 34.6% were female) with prior myocardial infarction and moderate ischemic mitral regurgitation undergoing off-pump coronary artery bypass grafting. Preoperative and follow-up clinical characteristics and echocardiography data were analyzed, focusing on left ventricular global/regional remodeling and function. Patients were grouped by postoperative ischemic mitral regurgitation at 1 year postoperatively: the improved group with no or mild ischemic mitral regurgitation and the failure group with moderate or severe ischemic mitral regurgitation. Data were compared between the 2 groups to explore the predictors of ischemic mitral regurgitation improvement after off-pump coronary artery bypass grafting.
  
  
  RESULTS
  Five patients died within 1 year and were excluded. At the 1-year follow-up, there were 55 patients in the improved group and 49 patients in the failure group. Before surgery, the improved group had smaller left ventricular end-systolic volume, greater left ventricular ejection fraction, greater posterior-inferior volume ratio, and earlier operation timing after infarction than the failure group. Posterior-inferior volume ratio (P < .001), ejection fraction (P = .003), and duration between infarction and operation (P < .001) were independent predictors of preoperative moderate ischemic mitral regurgitation improvement.
  
  
  CONCLUSIONS
  In selected patients, preoperative moderate ischemic mitral regurgitation was relieved by off-pump coronary artery bypass grafting. Greater ejection fraction, greater posterior-inferior volume ratio, and early operation timing after infarction may predict the improvement of moderate ischemic mitral regurgitation after off-pump coronary artery bypass grafting, suggesting that posterior-inferior regional remodeling, reserved ventricular function, and early revascularization are important to the outcome.
authors: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, P. R. China.
authors: Xiaotian
authors: X
authors: Sun
authors: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, P. R. China.
authors: Jiechun
authors: J
authors: Huang
authors: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, P. R. China.
authors: Meng
authors: M
authors: Shi
authors: Department of Echocardiography, Huashan Hospital of Fudan University, Shanghai, P. R. China.
authors: Guoqian
authors: G
authors: Huang
authors: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, P. R. China.
authors: Liewen
authors: L
authors: Pang
authors: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, P. R. China. Electronic address: WANGYIQING1965@qq.com.
authors: Yiqing
authors: Y
authors: Wang
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: coronary artery bypass grafting; mitral regurgitation; myocardial infarction; myocardial remodeling