Remote results of surgical treatment of moderate ischemic mitral regurgitation in patients with normal left ventricle function
Background. One of the complications of coronary heart disease is ischemic mitral regurgitation (IMR). Moderate IMR remains one of the challenges in devising the tactics for its correction. Objective. The study was aimed at comparing the results after coronary artery bypass grafting (CABG) alone and CABG with mitral valve annuloplasty (MVA) in patients with normal ejection fraction (EF) of the left ventricle (LV) or approximated one. Methods. The study included 93 CHD patients with moderate ischemic MR and normal or close to normal LVEF. 81 patients reached a 1-year research checkpoint when this paper was being prepared. All patients were randomized into two groups. The first group included 40 patients who underwent CABG alone, the second group included 41 patients who had underwent CABG plus MVA performed by using a complete annuloplasty ring. Mean age was 61.4±7.2 years, 60 (74%) patients were male. Mean LVEF was 45% (40; 53). Results. There was no early postoperative mortality (<30 days) in both groups. Survival at 1 year was similar in both groups: 93% in the CABG plus MVA group versus 97% in the CABG group. No statistical difference was observed in both groups. A year after surgery only 1 patient (3%) in the CABG group showed complete freedom from mitral regurgitation, while in the CABG plus MVA group there were 16 patients (42%). At 1 year after surgery, NYHA functional class of patients in the CABG plus MVA group decreased from 3 (2; 3) to 0 (0; 1) (p<0.001), while in the CABG alone group it dropped down from 3 (3; 3) to 2 (1; 2) (p<0.001). Conclusion. The addition of MVA to CABG effectively reduces the degree of moderate ischemic MR. Both methods improve the clinical condition of patients and the quality of life 1 year after surgery.