[Coronary artery bypass grafting surgery in left ventricular dysfunction patients complicated with mitral
Z X Wang1, X M Zhuang1, R Zhang1
1Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen 518057, China.
Insights
Coronary artery bypass grafting (CABG) surgery effectively treats left ventricular dysfunction with ischemic mitral regurgitation (IMR). Transesophageal echocardiography (TEE) guides treatment, with valve replacement improving cardiac function in severe cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Imaging
- Heart Valve Disease
Background:
- Left ventricular dysfunction (LVD) often coexists with ischemic mitral regurgitation (IMR).
- The optimal surgical strategy for IMR in LVD patients remains a focus of research.
- Accurate valve assessment is critical for successful surgical outcomes.
Purpose of the Study:
- To assess the effectiveness of coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction and varying degrees of ischemic mitral regurgitation (IMR).
- To determine the role of transesophageal echocardiography (TEE) in guiding surgical decisions for IMR.
- To evaluate the impact of different surgical interventions on postoperative cardiac function.
Main Methods:
- Retrospective analysis of 525 patients undergoing CABG between 2015 and 2018.
- Selection of 67 patients with moderate to severe IMR and left ventricular ejection fraction (LVEF) ≤40%.
- Utilized transesophageal echocardiography (TEE) for detailed assessment of mitral valve function and cardiac structures.
Main Results:
- In patients with moderate IMR and intact papillary muscles, CABG alone improved ventricular function without mitral valve intervention.
- For moderate-to-severe IMR with improved wall motion post-CABG, mitral valve treatment was not required.
- Severe IMR cases with papillary muscle or ring compromise benefited from valve repair (2 patients) or replacement (7 patients), leading to improved LVEF and reduced ventricular dimensions post-surgery.
Conclusions:
- Transesophageal echocardiography (TEE) is essential for evaluating valve function in patients with LVD and IMR.
- For moderate-to-severe IMR, valve replacement is recommended when ischemia significantly affects papillary muscle function and the mitral valve ring.
- Surgical intervention tailored to the degree of IMR and valve structure integrity improves postoperative cardiac function.
Abstract:
Objective: To evaluate the efficacy of coronary artery bypass grafting (CABG) surgery in left ventricular dysfunction patients complicated with different degrees of ischemic mitral regurgitation (IMR). Methods: The clinical data of 525 patients (428 males and 97 females) undergoing CABG in Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, and Tianjin Medical University General Hospital between January 2015 and December 2018 were collected. The average age was (61±7) years old. Among them, the patients with moderate to serve IMR and left ventricular ejection fraction(LVEF)≤40% were further selected, and the outcomes of CABG were analyzed. Results: In total, 67 patients (48 males and 19 females) with moderate to severe IMR and LVEF≤40% were enrolled, among which 52 patients had moderate IMR, with a LVEF of 38%(35%, 40%). Transesophageal echocardiography (TEE) of 52 cases displayed no damage of papillary muscles, and ventricular wall motion was improved after CABG. Therefore, no treatment on the mitral valve was performed in this group. Six patients were with moderate-severe mitral insufficiency, with a LVEF of 38%(35%, 39%). After surgery, TEE found that the ventricular wall motion and regurgitation were improved, and the mitral valve structures were well. Thus, mitral valves were not treated in these patients. Nine patients were with severe mitral regurgitation, with a LVEF of 38%(35%, 39%). Two of them received valve repair because the papillary muscle function and the ring were well. Another 7 patients received valve replacements because the valve ring was dilatated and the leaflet was prolapsed. All patients recovered well. The LVEF increased significantly at 6 months after surgery [47%(45%, 48%) vs 38%(35%, 39%), P=0.024], and the left ventricular end diastolic diameter also became smaller [57(56, 59) mm vs 61(59, 64) mm, P=0.002]. Conclusions: For patients suffered from left ventricular dysfunction complicated with IMR, TEE is crucial to evaluate the valve function. To those with moderate-severe regurgitation, if papillary muscle function and the ring were seriously affected by ischemia, the valve replacement could facilitate the improvement of postoperative cardiac function.
Related Concept Videos
01:25Mitral Regurgitation III: Medical Management
01:20Mitral Regurgitation I: Introduction
01:22Mitral Stenosis I: Introduction
01:26Mitral Stenosis III: Medical Management
01:28Mitral Regurgitation IV: Nursing Management
01:23Mitral Regurgitation II: Clinical Features and Diagnostic Tests