¿Se debe corregir la insuficiencia mitral isquémica moderada durante la cirugía coronaria?

Abstract

Significant ischemic mitral regurgitation is present in 28% of patients undergoing coronary revascularization. Their presence has prognostic implications deleterious to the patient. Randomized studies to assess the benefits of simultaneous correction during revascularization are rare. MethodsFinal results of the study (RIME) are analyzed: Coronary bypass revascularization with or without mitral annuloplasty in moderate functional ischemic mitral regurgitation. Results are compared with other recent studies and implications in current indications are commented. ResultsMitral valve annuloplasty with overcorrection associated to myocardial revascularization in patients with moderate ischemic mitral regurgitation, improves functional class and left ventricular reverse remodeling. Also decreases the degree of mitral regurgitation and the levels of pro-BNP. ConclusionThe ischemic mitral regurgitation is an independent factor of poor prognosis in patients with severe coronary lesions. Proper quantification of its severity is relevant to its indication at the time of revascularization. In many cases dynamic provocative tests will be necessary.Although the answer to the question posed by the study RIME can be interpreted as inconclusive in terms of survival, it has established significantly benefits in all markers of impaired left ventricular function during the short follow-up. It support the indication of mitral repair if moderate mitral regurgitation in low-risk patients.