Surgical Management of Ischemic Mitral Regurgitation

ObjectiveTo summarize the experience in surgical technique and clinical results of treating ischemic mitral regurgitation (IMR). MethodsFrom April 1998 to September 2004 fifty-three IMR patients, 8 with mild-moderate IMR, 24 with moderate IMR, and 21 with severe IMR, underwent coronary artery bypass grafting (CABG) combined with mitral valvuloplasty (MVP, n=33) or mitral valve replacement (MVR, n=20). The procedures of MVP included commissural annuloplasty in 14 cases, posterior ring annuloplasty in 18, and “double-orifice” technique in 1 case. In the cases undergoing MVR, mechanical valves were implanted in 18 patients and biological prosthesis was used in 2. Forty-two patients were followed up by outpatient department visit, telephone, or letter communication for 29 months. Results The total operative mortality was 15.09% (8/53) with the causes of death of heart failure in 4 cases, arrhythmia in 2 and multiple organ dysfunction syndrome in 2. Two cases of late death were recorded. Thirty-seven survivors showed the NYHA functional classⅠ-Ⅱ, and 3 survivors showed the class Ⅲ . Ultrasonic cardiography showed no or only trace mitral regurgitation (MR) in 17 cases undergoing MVP, mild MR in 6, and moderate MR in 3, all with the left ventricle size decreased significantly. There was 1 case of perivalvular leak in the MVR group. Statistical analysis showed that preoperative left ventricle ejection fraction and cardiac function were independent risk factors of operation, but operation protocol was not. ConclusionWhile performing CABG, moderate to severe IMR with pathological changes of mitral valve must be corrected by revascularization and mitral correction. The choice of protocol depends on the mitral pathology and experience of the surgeon. MVP and MVR have the similar effect on IMR.