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Surgical Management of Severe Ischaemic Mitral Regurgitation

Yong Zhang1, Dongxu Wang2, Yu Liu1

  • 1Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command, Shenyang, 110016, China.

Heart, Lung & Circulation
|May 27, 2017
PubMed

Insights

Coronary artery bypass graft surgery (CABG) combined with mitral valve replacement (MVR) or mitral valvuloplasty (MVP) showed similar short-term outcomes for severe ischaemic mitral regurgitation (IMR). Long-term efficacy of MVR versus MVP in IMR treatment requires further observation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Disease Management

Background:

  • Severe ischaemic mitral regurgitation (IMR) treatment often involves coronary artery bypass graft surgery (CABG) combined with mitral valve surgery.
  • The choice between mitral valve replacement (MVR) and mitral valvuloplasty (MVP) in conjunction with CABG remains a subject of debate.

Purpose of the Study:

  • To compare the short-term efficacy of CABG combined with MVP versus MVR in patients with severe IMR.
  • To evaluate postoperative outcomes including major adverse cardiac and cerebrovascular events (MACCE) and left ventricular remodeling.

Main Methods:

  • A cohort of 130 severe IMR patients undergoing CABG with either MVP (70 cases) or MVR (60 cases) from June 2010 to June 2015.
  • Postoperative assessment included MACCE, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD).

Main Results:

  • No significant difference in cumulative survival rates or MACCE between MVP and MVR groups at 12-month follow-up.
  • Significant improvements in LVEDD, LVESD, and systolic pulmonary artery pressure (sPAP) were observed in both groups, with no inter-group difference.
  • The MVR group demonstrated a significantly lower rate of moderate to severe mitral regurgitation postoperatively compared to the MVP group.

Conclusions:

  • Short-term outcomes, including survival, left ventricular remodeling, and MACCE, are comparable between CABG with MVP and CABG with MVR for severe IMR.
  • Further long-term studies are necessary to ascertain the definitive efficacy of MVR versus MVP in this patient population.
Abstract

Keywords:
Cardiac surgeryCoronary artery bypass graftingIschaemic mitral regurgitationLeft ventricular remodellingMitral valve repair

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