The Progress of Mitral Regurgitation after Isolated Coronary Artery Bypass in Cases of Ischemic Mitral Regurgitation

Authors

  • Ali Gürbüz
  • Banu Lafci
  • Sahin Bozok
  • Levent Yilik
  • Ibrahim Özsöyler
  • Orhan Gökalp
  • Nagihan Karahan
  • Cengiz Özbek

DOI:

https://doi.org/10.1532/HSF98.20051015

Abstract

Background. Mitral valve intervention combined with coronary artery bypass surgery is inevitable in the case of severe mitral regurgitation in patients with coronary artery disease because the prognosis is poor without mitral correction. The best treatment protocol for patients with a moderate degree of mitral regurgitation is under debate. To clarify the optimal management for these patients, we evaluated the progress of mitral regurgitation after isolated coronary artery bypass surgery in cases of ischemic mitral regurgitation.

Methods. The study was conducted between March 2001 and April 2003. Forty-seven patients (70% men, with a mean age of 61 years, a mean ejection fraction of 43.7%, and a mean New York Heart Association class of 2.53) with preoperative diagnoses of moderate degree ischemic mitral regurgitation (Grade 3 mitral regurgitation on a scale of 0 to 4) and coronary artery disease, without leaflet pathology, underwent isolated coronary artery bypass surgery. Patients were followed-up at a mean of 22 months and an echocardiographic evaluation was done to determine the progress of the mitral disease.

Results. The 30-day operative mortality rate was 2.1%. In the postoperative period, the mean ejection fraction was 46.9% and the mean functional capacity of the patients was 1.31. Mitral regurgitation regressed to a mild degree in 56.9% of the patients. The 2-year survival rate was 93.7%.

Conclusions. Patients with moderate ischemic mitral regurgitation and coronary artery disease who underwent coronary artery bypass surgery alone had acceptable results. We are of the opinion that isolated coronary artery bypass surgery might be a good treatment choice for moderate degree ischemic mitral regurgitation.

References

Pinson CW, Cobanoglu A, Metzdorff MT, et al. 1984. Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation. J Thorac Cardiovasc Surg 88(5 Pt 1): 663-72.nDuarte IG, Shen Y, MacDonald MJ, et al. 1999. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone: late results. Ann Thorac Surg 68:426-30.nFlameng W, Szecsi J, Sergeant P, et al. 1994. Combined valve and coronary artery bypass surgery: early and late results. Eur J Cardiothorac Surg 8:410-9; discussion 419.nGangemi JJ, Tribble CG, Ross SD, et al. 2000. Does the additive risk of mitral valve repair in patients with ischemic cardiomyopathy prohibit surgical intervention? Ann Surg 231:710-4.nHausmann H, Siniawski H, Hetzer R. 1999. Mitral valve reconstruction and replacement for ischemic mitral insufficiency: seven years' follow up. J Heart Valve Dis 8:536-42.nKim YH, Czer LSC, Soukiasian HJ, et al. 2005. Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg 79:1895-901nRankin JS, Hickey MS, Smith LR, et al. 1989. Current management of mitral valve incompetence associated with coronary artery disease. J Cardiac Surg 4:25-42.nRuvolo G, Speziale G, Bianchini R, et al. 1995. Combined coronary bypass grafting and mitral valve surgery: early and late results. Thorac Cardiovasc Surg 43:90-3.nVon Oppell UO, Stemmet F, Brink J, et al. 2000. Ischemic mitral valve >repair surgery. J Heart Valve Dis 9:64-73; discussion 73-4.nYun KL, Miller DC. 1991. Mitral valve repair versus replacement. Cardiol Clinics 9:315-27.nAdler DS, Goldman L, O'Neil A, et al. 1986. Long-term survival of more than 2,000 patients after coronary artery bypass grafting. Am J Cardiol 58:195-202.nAkins CW, Hilgenberg AD, Buckley MJ, et al. 1994. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg 58:668-75; discussion 675-6.nAklog L, Filsoufi F, Flores KQ, et al. 2001. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation 104(Suppl 1):I68-75.nArcidi JM Jr, Hebeler RF, Craver JM, et al. 1988. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone. J Thorac Cardiovasc Surg 95:951-9.nBalu V, Hershowitz S, Zaki Masud AR, et al. 1982. Mitral regurgitation in coronary artery disease. Chest 81:550-5.nBolling SF, Deeb GM, Bach DS. 1996. Mitral valve reconstruction in elderly, ischemic patients. Chest 109:35-40. Chen FY, Adams DH, Aranki SF, et al. 1998. Mitral valve repair in cardiomyopathy. Circulation 98(19 Suppl):II124-7.nChristenson JT, Simonet F, Bloch A, et al. 1995. Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis 4:484-8; discussion 488-9.nCohn LH, Rizzo RJ, Adams DH, et al. 1995. The effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement. Eur J Cardiothorac Surg 9: 568-74.nConnolly MW, Gelbfish JS, Jacobowitz, et al. 1986. Surgical results for mitral regurgitation from coronary artery disease. J Thorac Cardiovasc Surg 91:379-88.nDion R, Benetis R, Elias B, et al. 1995. Mitral valve procedures in ischemic regurgitation. J Heart Valve Dis 4(Suppl 2):S124-9; discussion S129-31.nGrigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. 2001.nIschemic mitral regurgitation long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103: 1759-64.nHickey MS, Smith LR, Muhlbaier LH, et al. 1988. Current prognosis of ischemic mitral regurgitation: implications for future management. Circulation 78(3 Pt 2):I51-9.nIzhar U, Daly RC, Dearani JA, et al. 1999. Mitral valve replacement or repair after previous coronary artery bypass grafting. Circulation 100 (19 Suppl):II84-9.n

Published

2006-01-13

How to Cite

Gürbüz, A., Lafci, B., Bozok, S., Yilik, L., Özsöyler, I., Gökalp, O., Karahan, N., & Özbek, C. (2006). The Progress of Mitral Regurgitation after Isolated Coronary Artery Bypass in Cases of Ischemic Mitral Regurgitation. The Heart Surgery Forum, 9(2), E555-E559. https://doi.org/10.1532/HSF98.20051015

Issue

Section

Articles

Most read articles by the same author(s)