Risk factors for the return of mitral insufficiency after coronary artery bypass graft and reconstruction of the mitral valve in patients with ischemic cardiomyopathy

Abstract

Aim. This study aimed to compare the surgical correction results for isolated coronary artery bypass graft (CABG) and CABG in combination with mitral valve (MV) repair for moderate ischemic mitral insufficiency (IMI) in patients with ischemic cardiomyopathy and to identify the risk factors for MI return.Methods. This single-centre prospective study enrolled 76 patients with ischemic cardiomyopathy and moderate MI with a left ventricular ejection fraction < 35% who did not undergo left ventricular reconstruction. The patients were treated with isolated CABG or CABG in combination with MV repair. The mean age of the patients was 57.5 ± 8.6 years (range, 30–75 years), and 90% were men. Isolated annuloplasty was used with a rigid support ring brand with a ring size of 26–30 mm to correct mitral insufficiency in the CABG + MV repair group.Results. We found that isolated CABG or CABG + MV repair in patients with ischemic heart disease and severe systolic left ventricular dysfunction does not result in significant decrease in the MI in the long term compared with that at baseline. However, the degree of MI after CABG + MV repair is lower than the initial values, unlike that after isolated CABG 12 months postoperatively. In the observation period, of up to 36 months, the MI degree after isolated CABG corresponds to the initial values. The determination of the predictors of IMI progression in ischemic cardiomyopathy enabled us to determine the threshold values of the performance indicators of MV repair, and the evaluation of Echo predictors for annuloplasty preoperatively help select the surgical treatment strategies for patients with ischemic cardiomyopathy and moderate MI.Conclusion. Correction of IMI in patients with ischemic cardiomyopathy does not increase the number of complications in the early postoperative period compared to isolated CABG (p = 0.015). After isolated CABG in patients with ischemic cardiomyopathy and moderate MI, progression of mitral regurgitation (grade 3 mitral regurgitation, initially 0%; after 12 months, 31%; after 36 months, 71%; p < 0.001) is observed even with initially moderate changes in the geometry of the mitral valve.Received 6 December 2018. Revised 25 March 2019. Accepted 28 March 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.