Objectives: The objective of this study was to assess the feasibility of mitral valve (MV) surgery combined with coronary artery bypass grafting (CABG) in patients with mild-to-moderate and moderate ischaemic mitral valve (MV) regurgitation and impaired left ventricular (LV) function. Methods: Between 1996 and 2012, 90 patients (group 1) and 70 patients (group 2) with grade II-III ischaemic MV regurgitation and LV ejection fraction (LVEF) between 17% and 30% underwent combined MV surgery and CABG (group 1) or isolated CABG (group 2). LVEF (%), left ventricular end diastolic diameter (LVEDD) (mm), left ventricular end diastolic pressure (LVEDP) (mmHg), and left ventricular end systolic diameter (LVESD) (mm) were 27.5 ± 5, 67.7 ± 7, 27.7 ± 4, and 51.4 ± 7 in group 1 versus 27.8 ± 4, 67.5 ± 6, 27.5 ± 5, and 51.2 ± 6 in group 2 respectively. MV repair was performed in 73 (81%) patients and MV replacement in 17 (19%) patients in group 1. Results: The hospital mortality was nine (10%) patients in group 1 vs nine (12.8%) in group 2 (P = NS). Within six months after surgery, the LV function and its geometry improved significantly in group 1 vs group 2 (LVEF P < 0.001, LVEDD P = 0.002, LVESD P = 0.003 and LVEDP P < 0.001). The regurgitation fraction decreased significantly in group 1 patients after surgery (P < 0.001). There was an inverse strong correlation between postoperative forward cardiac output and regurgitation fraction (P < 0.001). The LVEF and LVESD improved significantly in group 1 versus group 2 patients, P = 0.04 and P = 0.02 respectively. The cardiac index increased significantly in groups 1 and 2, P < 0.001 and P = 0.03 respectively. The overall survival at 5 years in group 2 was significantly lower than group 1 (P < 0.009). Conclusions: The surgical correction of mild-to-moderate and moderate MV regurgitation in patients with impaired LV function should be taken into consideration, yielding better survival and improved LV function.
SHOULD MILD-TO-MODERATE ISCHAEMIC MITRAL REGURGITATION BE CORRECTED IN PATIENTS WITH IMPAIRED LEFT VENTRICULAR FUNCTION UNDERGOING SIMULTANEOUS CORONARY REVASCULARIZATION? / E. Prifti;M. Bonacchi;G. Giunti;E. Kajo;K. Krakulli;A. Fagu;A. Baboci. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - STAMPA. - 17:(2013), pp. S72-S72. [10.1093/icvts/ivt372.14]
SHOULD MILD-TO-MODERATE ISCHAEMIC MITRAL REGURGITATION BE CORRECTED IN PATIENTS WITH IMPAIRED LEFT VENTRICULAR FUNCTION UNDERGOING SIMULTANEOUS CORONARY REVASCULARIZATION?
BONACCHI, MASSIMO;
2013
Abstract
Objectives: The objective of this study was to assess the feasibility of mitral valve (MV) surgery combined with coronary artery bypass grafting (CABG) in patients with mild-to-moderate and moderate ischaemic mitral valve (MV) regurgitation and impaired left ventricular (LV) function. Methods: Between 1996 and 2012, 90 patients (group 1) and 70 patients (group 2) with grade II-III ischaemic MV regurgitation and LV ejection fraction (LVEF) between 17% and 30% underwent combined MV surgery and CABG (group 1) or isolated CABG (group 2). LVEF (%), left ventricular end diastolic diameter (LVEDD) (mm), left ventricular end diastolic pressure (LVEDP) (mmHg), and left ventricular end systolic diameter (LVESD) (mm) were 27.5 ± 5, 67.7 ± 7, 27.7 ± 4, and 51.4 ± 7 in group 1 versus 27.8 ± 4, 67.5 ± 6, 27.5 ± 5, and 51.2 ± 6 in group 2 respectively. MV repair was performed in 73 (81%) patients and MV replacement in 17 (19%) patients in group 1. Results: The hospital mortality was nine (10%) patients in group 1 vs nine (12.8%) in group 2 (P = NS). Within six months after surgery, the LV function and its geometry improved significantly in group 1 vs group 2 (LVEF P < 0.001, LVEDD P = 0.002, LVESD P = 0.003 and LVEDP P < 0.001). The regurgitation fraction decreased significantly in group 1 patients after surgery (P < 0.001). There was an inverse strong correlation between postoperative forward cardiac output and regurgitation fraction (P < 0.001). The LVEF and LVESD improved significantly in group 1 versus group 2 patients, P = 0.04 and P = 0.02 respectively. The cardiac index increased significantly in groups 1 and 2, P < 0.001 and P = 0.03 respectively. The overall survival at 5 years in group 2 was significantly lower than group 1 (P < 0.009). Conclusions: The surgical correction of mild-to-moderate and moderate MV regurgitation in patients with impaired LV function should be taken into consideration, yielding better survival and improved LV function.
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