Mitral valve surgery simultaneous to coronary revascularization in patients with end-stage ischemic cardiomyopathy

Massimo Bonacchi, Edvin Prifti, Massimo Maiani, Giacomo Frati, Nadia S. Nathan, Marzia Leacche

Research output: Contribution to journalArticle

Abstract

Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, predicts a poor outcome in terms of survival and morbidity. Between 1995 and 2003, 180 consecutive patients with impaired LV function and chronic ischemic MVR underwent cardiac surgery. Fifty-four patients (group I), MVR (grade III-IV) underwent simultaneous MV surgery and coronary artery bypass grafting (CABG); 40 patients (group II), MVR (grade II-III), and 86 patients (group III), MVR (grade I-II), underwent CABG alone. In group I, MV repair was performed in 36 patients (group IA) and MV replacement in 18 (group IB). The incidence of hospital death was similar between groups. The actuarial event-free survival was significantly lower in group than in groups II and III (P = 0.0045) and I (P = 0.038). The overall actuarial survival was significantly higher in group IA than in group IB (P = 0.027). Postoperatively, the LV ejection fraction (P <0.001), LV end-diastolic diameter (P <0.001), LV end-systolic diameter (P <0.01), and cardiac index (P <0.001) improved significantly in group I. The regurgitation fraction decreased significantly in Groups I and III after surgery (P <0.001 and P = 0.003, respectively). Both MV repair and replacement that preserves subvalvular apparatus in patients with end-stage ischemic myocardiopathy offer an acceptable outcome. Mitral valve repair simultaneous to CABG improves significantly the LV function and its geometry. In patients with mild to moderate mitral regurgitation, CABG alone may be performed with good overall survival, but with lower event-free survival than those undergoing concomitant mitral valve repair.

Original languageEnglish
Pages (from-to)20-27
Number of pages8
JournalHeart and Vessels
Volume21
Issue number1
DOIs
Publication statusPublished - Jan 2006

Keywords

  • Coronary artery bypass grafting
  • Impaired left ventricular function
  • Mitral valve repair
  • Mitral valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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