Results of Coronary Artery Bypass Grafting Alone Versus Combined Surgical Revascularization and Mitral Repair In
Ahmed Khallaf1, Mahmoud Elzayadi1, Hesham Alkady2
1Department of Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt.
Insights
Adding mitral valve repair to coronary artery bypass grafting significantly improves outcomes for patients with moderate ischemic mitral regurgitation. This combined approach enhances functional class and reduces regurgitation more effectively than bypass alone.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Ischemic Heart Disease
Background:
- Moderate ischemic mitral regurgitation (IMR) often accompanies ischemic heart disease.
- Optimal surgical management for moderate IMR remains a subject of investigation.
Purpose of the Study:
- To compare the efficacy of coronary artery bypass grafting (CABG) alone versus CABG with concurrent mitral valve repair for moderate IMR.
Main Methods:
- A prospective randomized-controlled study involving 60 patients with IHD and moderate IMR.
- Patients were divided into two groups: CABG with mitral repair (Group 1) and CABG alone (Group 2).
Main Results:
- Group 1 showed significant improvement in NYHA class (2.7 to 1.35) and mitral regurgitation (MR) degree (93% improvement).
- Group 2 showed less improvement in NYHA class (2.6 to 1.72) and MR degree (73% improvement).
- Operative times were longer in Group 1, but there were no significant differences in postoperative course or mortality.
Conclusions:
- Adding mitral repair to CABG offers significant advantages for patients with moderate IMR.
- The combined procedure improves MR severity and functional capacity without increasing mortality risk.
Background:
This is a prospective randomized-controlled study done to evaluate the best surgical option for moderate ischemic mitral regurgitation through either coronary artery bypass grafting only or by performing additional mitral repair.
Methods:
Over a nine-month period, 60 patients with ischemic heart disease associated with moderate ischemic mitral regurgitation were equally divided into two groups. Group 1 included 30 patients who had coronary artery bypass grafting with mitral valve repair; Group 2 included 30 patients who had only coronary artery bypass grafting.
Results:
There were no significant differences between the study groups, regarding operative data, apart from the cardiopulmonary bypass time and aortic cross-clamp time, which were significantly longer in group 1 (P < 0.001). Only one patient died in group 1 due to severe myocardial dysfunction. During the follow up, the NYHA class improved in group 1, from 2.7 to 1.35 (P < 0.004), compared with group 2, where the NYHA class improved from 2.6 to 1.72 (P = 0.07). The degree of MR improved in 28 patients (93%) in group 1 and 22 patients (73%) in group 2 (P < 0.0001).
Conclusion:
The study revealed many advantages of adding mitral repair to surgical revascularization in patients with moderate ischemic mitral regurgitation, with improvement in the degree of MR and NYHA functional class. On the other hand there were no significant differences between the groups, regarding the postoperative course and incidence of mortality.
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