effect of intraoperative repair of mild-to-moderate and moderate ischemic mitral valve regurgitation on the postoperative results of coronary artery bypass graft surgery

ABSTRACT

Patients undergoing bypass grafting [CABG] often present with mitral regurgitation [MR]. While surgical strategy for patients with either trace or severe MR is well established, the need for a valve procedure with mild-to-moderate and moderate mitral regurgitation is still controversial. This study aims at evaluating the impact of intraoperative repair of mild-to-moderate or moderate ischemic mitral valve regurgitation on the early postoperative results of Coronary Artery Bypass Graft Surgery. Our prospective comparative study was done in the Department of Cardiothoracic Surgery of Kasr El Aini University French Teaching Hospitals as well as private hospitals after approval of the local ethical committee. The study included 60 consecutive CABG patients 13 women [21.6%] and 47 men [78.3%] with a mean age of 59 +/- 3.5 years [range 39-66 years] which were operated upon between 2004 and 2006. Patients were divided into two adequately-matched groups group A [no 30] included patients who carried out mitral repair concomitant with CABG; and group B [no 30] which included patients who were submitted to CABG only. Data was collected prospectively in the 1st. group patients and retrospectively in the 2nd. group patients. Preoperative patient characteristics, as well as the general operative techniques used, were comparable between patients of both groups. Preoperative Clinical and Echocardiographic examination in all patients proved the presence of mild to moderate or moderate ischemic mitral regurgitation [NYHA Clinical grades 1-2 or grade 2]. Similar Comorbidity conditions were present in both groups. Follow-up was done by clinical and echocardiographic examination for 1st. postoperative year to assess early and short-term results and identify independent predictors for early and short-term postoperative risk. A single patient [3.3%] died in group A patients; versus 4 patients [13.3%] in group B. [p< 0.01]. Better clinical improvement [NYHA step-up for milder sypmtoms]; and functional results [earlier return to work]; together with more echocardiographic improvement [LVEDD, LVESD, LA diameter, LVEF%, and surface area of the MR jet] occurred in group A versus group B patients. Morbidity occurred more in 6 [20%] of group B patients; versus 4 patients [13.3%] in group A with no statistical significance. Independent predictors of poor postoperative outcome of CABG surgery were female sex; preoperative LVEF dysfunction, frequent preoperative infarctions, poor NYHA Class; prior cerebrovascular accident and incomplete revascularization. We found that intraoperative repair of mild-to-moderate or moderate ischemic MR during coronary artery bypass graft surgery led to a better intraoperative and postoperative outcome compared to those in whom CABG surgery was done alone. Being associated with acceptably-less mortality and morbidity complications in the immediate and early postoperative periods we justify its safe use in this context