|
Ischemic Mitral Valve Regurgitation Grade II-III Correction in Patients with
Impaired Left Ventricular Function undergoing Simultaneous Coronary
Revascularization Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, is predictive of poor outcome. Mitral valve surgery concomitant with CABG was assessed in patients with ischemic MVR grade II-III and impaired LV function. Ninety-nine patients with grade II/III ischemic MVR and LV ejection fraction (LVEF) 17-30% underwent either combined mitral valve surgery and CABG (group I) or isolated CABG (group II). LVEF (%), LVEDD (mm), LVEDP (mmHg), LVESD (mm) respectively were 27.5 ± 5, 67.7 ± 7, 27.7 ± 4 and 51.4 ± 7 in group I versus 27.8 ± 4, 67.5 ± 6, 27.5 ± 5 and 51.2 ± 6 in group II. Mitral valve repair was performed in 43 patients (88%), and replacement in six patients (12%) in group I. Preoperative data analysis showed no inter-group differences. Five patients (10%) died in group I, and six (12%) in group II (p = NS). Within six months after surgery, LV function and geometry improved significantly in group I versus group II (LVEF, p <0.001; LVEDD, p = 0.002; LVESD, p = 0.003, LVEDP, p <0.001). The regurgitation fraction decreased significantly in group I patients after surgery (p <0.001). Cardiac index increased significantly in groups I and II (p <0.001 and p = 0.03). In group I, at follow up four of six patients undergoing mitral valve replacement died, compared with five of 43 patients (11.5%) undergoing mitral valve repair (p = 0.007). At three years, overall survival in group II was significantly lower than in group I (p <0.009). To conclude, both mitral valve repair and replacement preserving subvalvular apparatus in patients with impaired LV function provided acceptable outcome in terms of morbidity and survival. Surgical correction of grade II-III MVR in patients with impaired LV function provides better survival and improved LV function. |
754 |