Efficacy of add mitral valve restrictive annuloplatsy to CABG in patients with moderate ischemic mitral valve regurgitation
Khalil Fattouch, Francesco Guccione, Marco Muscarelli, Emiliano Navarra, Davide Calvaruso, Giuseppe Speziale, Giovanni Ruvolo; Cardiac Surgery, University of Palermo, Palermo, Italy
Comment on this Abstract
Objective: Surgical management of moderate ischemic mitral valve regurgitation (I-MR) is still debated. In this study, we evaluate prospectively and randomly the early and midterm results of patients with moderate IMR underwent CABG or CABG + mitral valve repair (MVR).
Methods: Between February 2003 and May 2007, 102 patients with moderate IMR were prospectively and randomly enrolled to undergo CABG+MVR (48pts/47%) or CABG alone (54pts/53%). Standard CABG procedures was performed in all patients. Restrictive mitral valve annuloplasty using a Carpentier-Edwards phisio ring was applied for MVR. Preoperative demographics and clinical data, intraoperative characteristics, postoperative outcomes, postoperative mitral valve regurgitation grade, NYHA functional class at follow-up, in-hospital and late survival, left ventricular remodeling and pulmonary arterial pressure (PAP) were recorded. Exercise tolerance was performed for all survivors. There was one late cardiac related death. The mean follow-up was 28±6 months.
Results: Overall in-hospital mortality was 3% (3 pts). One patient dead in CABG group (1.8%) and 2 pts in CABG+MVR group (4.1%). Predictors of early mortality were, preoperative poor LVEF % and age. The 2 groups were similar with regard to pre- and intraoperative data, excluding for CPB time (p < 0.05). At follow-up, in CABG group we showed a residual postoperative moderate to severe MR in 40 pts (75%). This data suggests that in only 25% of patients the CABG alone could be effective to decrease the severity of MR. In the CABG+MVR group, trivial MR was found in only 4 pts (8%). At follow-up, significant statistical difference was observed between groups respect to NYHA functional class, to left ventricular functionand remodelling, and to mean pulmonary arterial pressure. Patients in CABG group need more re-hospitalization, medical therapies and have decrease in exercise tolerance respect to CABG+MVR group.
Conclusion: In patients with moderate IMR, combined CABG and MV restrictive annuloplasty have slightly high mortality respect to CABG alone in elderly patients and in those with poor left ventricular function without statistical difference. On the other hand, add MVR to CABG improve postoperative NYHA functional class, ventricular remodeling and function, decrease postoperative PAP, that leads to less in medical therapeutics administration, re-hospitalization and tolerance to exercise.
Back to 88th Annual Meeting
Back to Program Outline
