[Comparative analysis of myocardial revascularisation and combined surgery impact on left ventricular function in...

The aim of study was to evaluate the impact of isolated myocardial revascularisation (MR) and combined surgery (MR) with mitral valve (MV) repair) on early and late postoperative changes of left ventricular ( LV) function. The study group consisted of 133 CAD pts with low LV ejection fraction (28.6+/-4.1%) and = II degrees MV incompetence, including 73 pts who underwent isolated MR (1 gr.) and 60 pts - MR with MV repair (2 gr.). Echocardiographic investigations performed preoperatively, early (10-14 th day) and late (following 1 year) after surgery, included evaluation of 1) LV morphometry, 2) systolic function indices, 3) pulmonary artery pressure (PAP) and 4) severity of MV incompetence.

At late follow up severity of MV incompetence did not differ from the preoperative in 1 gr., but was significantly lower in 2 gr. (2.8+/-0.5 versus 1.6+/-0.7, p<0.05). Preferable LV function changes were noted in 1 gr. at early follow up, but at late follow up - LV end diastolic diameter index increased and exceeded preoperative values (from 29.6+/-4.4 to 31.3+/-4.1 mm/m(2), p<0.05), as well as segmental contraction index and PAP (from 31.9+/-7.0 to 39.5+/-17.4 mmH, p<0.05). Early LV function improvement in 2 gr. remained stable at late follow up.

Combined surgery (MR with MV repair) in pts with ischemic cardiomyopathy and = II degrees MV incompetence has marked positive impact on LV remodelling: late follow up revealed no progression of LV dilation and significantly reduced severity of mitral regurgitation. One year following isolated MR severity of MV incompetence remained unchanged with progression of LV dilation and increase in PAP.