Surgical strategy for moderate ischemic mitral valve regurgitation: repair or ignore?

ABSTRACT

BACKGROUND: Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR. METHODS: A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography. RESULTS: Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (P = .006 and P = .020 respectively, in the intervention group, P = .001 and P = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (P = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control. CONCLUSION: Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.