Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient?

Authors

  • Hunbo Shim, MD Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea
  • Ji-won Hwang, MD Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Kyunggi-do, Korea
  • Won-Sang Chung, MD Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea
  • Chun Ki Kim, MD Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
  • Byung Jo Park, MD Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Young Tak Lee, MD Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Wook Sung Kim, MD Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

DOI:

https://doi.org/10.1532/hsf.2759

Keywords:

mitral valve replacement, mitral regurgitation, subvalvular

Abstract

Background: The progress of mild ischemic mitral regurgitation (MR) after isolated coronary artery bypass is not clear. We aimed to determine the proportion of patients with mild ischemic MR undergoing isolated coronary artery bypass grafting (CABG) presenting with regression of or persistent MR one year after CABG and to identify the significantly different echocardiographic variables between regressing and persistent MR.

Methods: Sixty-three patients with preoperative mild ischemic MR were categorized into an MR-
regression or an MR-persistence group one year after isolated CABG. The echocardiographic indices, indicating mitral leaflet configuration and remodeling of the left ventricle (LV), were measured before and one year after
the surgery.

Results: One year after CABG, MR regressed in 60% (38/63) and persisted in 40% (25/63) of the patients. The left ventricular diameter, volume, and sphericity and anteroposterior diameter of the mitral annulus improved only in the MR-regression group, while the ejection fraction improved in both groups (47.7% ± 12.4% from 40.1% ± 11.3%,
P < .001 in the regression group and 43.2% ± 14.0% from 39.3% ± 11.6%, P = .035 in the persistence group). A >15% decrease in the LV end-systolic volume was noted more frequently in the MR-regression group (60.5% versus 30%,
P = .027). The leaflet angle did not show asymmetry or significant changes in both groups.

Conclusions: Isolated CABG improved mild MR in most patients with mild ischemic MR. These patients showed greater reverse remodeling after revascularization than the patients with persistent MR after isolated CABG. Additional tests, which can predict LV reverse remodeling, are needed to predict persistent MR.

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Published

2020-05-29

How to Cite

Shim, H., Hwang, J.- won, Chung, W.-S., Kim, C. K., Park, B. J., Lee, Y. T., & Kim, W. S. (2020). Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient?. The Heart Surgery Forum, 23(3), E370-E375. https://doi.org/10.1532/hsf.2759

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