Surgical Management of Severe Ischaemic Mitral Regurgitation

Abstract

Coronary artery bypass graft surgery (CABG) with mitral valve surgery is undisputed in severe ischaemic mitral regurgitation (IMR) treatment, but the controversy is whether mitral valve replacement (MVR) or mitral valvuloplasty (MVP) should be used. Data was collected from 130 cases of severe IMR patients who underwent CABG and MVP or MVR from June 2010 to June 2015 to compare the short-term efficacy of CABG with MVP or MVR in the treatment of severe IMR patients. There were 70 cases in the MVP group and 60 in the MVP group. The postoperative major cardiac cerebral vascular events and left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD) were recorded. Eleven patients died in hospital, the remaining patients were followed up for 12 months; 18 patients died. The cumulative survival rate and the major cardiac cerebrovascular events were not significantly different. There was no significant change in LVEF, but LVEDD, LVESD and systolic pulmonary artery pressure (sPAP) improved significantly, and there was no difference between the groups. In the MVR group, the rate of postoperative moderate or severe mitral regurgitation patients was significantly less than that in the MVP group. The short-term survival rate, reversal of left ventricular remodelling and major cardiac or cerebrovascular events post-CABG combined with MVP were not significantly different to those with CABG combined with MVR in the treatment of severe IMR, but long-term efficacy remains to be observed.