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Mitral valve surgery simultaneous to coronary revascularization in patients with end-stage ischemic cardiomyopathy

Massimo Bonacchi1, Edvin Prifti, Massimo Maiani

  • 1Cattedra e Scuola di Specializzazione in Cardiochirurgia, Università degli Studi di Firenze, University Hospital of Florence Careggi, Florence, Italy. mbonacchi@unifi.it

Heart and Vessels
|January 28, 2006
PubMed

Insights

Mitral valve repair during coronary artery bypass grafting improves left ventricular function and survival in ischemic heart disease patients. CABG alone offers good survival but lower event-free survival for mild-moderate mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Valve Disease

Background:

  • Ischemic mitral regurgitation (MVR) linked to myocardial ischemia and left ventricular (LV) dysfunction predicts poor outcomes.
  • Chronic ischemic MVR in patients with impaired LV function poses significant clinical challenges.

Purpose of the Study:

  • To evaluate the outcomes of surgical interventions for ischemic MVR in patients with impaired LV function.
  • To compare the effectiveness of concomitant mitral valve surgery with CABG versus CABG alone.

Main Methods:

  • Retrospective analysis of 180 patients with impaired LV function and chronic ischemic MVR between 1995 and 2003.
  • Patients were divided into three groups: Group I (simultaneous MV surgery and CABG), Group II (CABG alone for moderate MVR), and Group III (CABG alone for mild MVR).
  • Group I was further divided into MV repair (IA) and MV replacement (IB).

Main Results:

  • Hospital death rates were similar across groups. Actuarial event-free survival was significantly lower in Group III compared to Groups I and II.
  • Overall actuarial survival was significantly higher in Group IA (MV repair) than in Group IB (MV replacement).
  • Postoperative improvements in LV ejection fraction, LV dimensions, and cardiac index were significant in Group I. Regurgitation fraction decreased significantly in Groups I and III.

Conclusions:

  • Both mitral valve repair and replacement, preserving subvalvular apparatus, yield acceptable outcomes in end-stage ischemic cardiomyopathy.
  • Mitral valve repair concurrent with CABG significantly enhances LV function and geometry.
  • For mild to moderate ischemic MVR, CABG alone provides good survival, but concomitant MV repair offers superior event-free survival.

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