Ischemic mitral valve regurgitation grade II-III: Correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization

Background and aim of the study: Mitral valve regurgitation (MVR), occurrin g as a result of myocardial ischemia and global left ventricular (IV) dysfu nction, is predictive of poor outcome. The study aim was to assess the feas ibility of mitral valve surgery concomitant with coronary artery bypass gra fting (CABG) in patients with ischemic MVR grade II-III and impaired IV fun ction. Methods: Between January 1996 and July 2000, 99 patients with grade II and III ischemic MVR and IV ejection fraction (LVEF) 17-30% underwent either co mbined mitral valve surgery and CABG (group I, n = 49) or isolated CABG (gr oup II, n = 50). LVEF (%), IV end-diastolic diameter (LVEDD; mm), IV end-di astolic pressure (LVEDP; mmHg), IV end-systolic diameter (LVESD; min) respe ctively were 27.5 +/- 5, 67.7 +/- 7, 27.7 +/- 4 and 51.4 +/- 7 in group I v ersus 27.8 +/- 4, 67.5 +/- 6, 27.5 +/- 5 and 51.2 +/- 6 in group II. In gro up I, mitral valve repair was performed in 43 patients (88%) and replacemen t in six (12%). Results: Preoperative data analysis showed no difference between groups. Fi ve patients (10%) died in group I, compared with six (12%) in group II (p = NS). Within six months of surgery, IV function and geometry improved signi ficantly in group I versus group II (LVEF, p <0.001; LVEDD, p = 0.002; LVES D, p = 0.003, LVEDP, p <0.001); only mild improvements were seen in group I I. The regurgitation fraction decreased significantly in group I patients a fter surgery (p <0.001). Cardiac index increased significantly in groups I and II (p <0.001 and p = 0.03, respectively). In group I at follow up, four of six patients undergoing mitral valve replacement died, compared with fi ve of 43 patients (11.5%) undergoing mitral valve repair (p = 0.007). At th ree years, the overall survival in group II was significantly lower than in group I (p <0.009). Conclusion: Both MV repair and replacement preserving subvalvular apparatus in patients with impaired IV function offered acceptable outcome in terms of morbidity and survival. Surgical correction of grade II-III WR in patien ts with impaired IV function should be taken into consideration as it provi des better survival and improves IV function.