Repair Versus Replacement for Ischemic Mitral Regurgitation In Patients Who Underwent Coronary Artery Bypass Grafting Plus Mitral Valve Surgery

Background: Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The optimal management of IMR is controversial. Although practice guidelines advise surgical intervention for patients presenting with a severe form of this condition, they also recognize the limited evidence supporting repair or replacement. Aim of the study: to analyse and compare the early outcomes of mitral valve repair (MVr) versus mitral valve replacement (MVR) with concomitant CABG in patients with IMR. Methods: A retrospective comparative study on 100 patients who underwent concomitant CABG for their coronary artery disease (CAD) and a mitral valve surgery for IMR, either MVr or MVR, between August 2021 and August 2023, at National Heart Institute. The patients were divided into four groups: group I (No=50) who underwent MVr and group II (N=50) who underwent MVR. Results: In group Ia, the mean age was 54.25±10.04 years. Among the study group 75% were males, 70% were diabetic and 60% were hypertensive, The mean pre-operative EF was 50.65±7.66%. The mean bypass time was 120.50±31.86 min and the mean cross clamp time was 94.50±29.28 min. The mortality rate was 5%. In group IIa, the mean age was 53.55±8.88 years. Among the study group 65% were males, 65% were diabetic and 85% were hypertensive. The mean pre-operative EF was 55.75±10.49%. The mean bypass time was 133.44±25.08 min and the mean cross clamp time was107.22±28.84 min. The mortality rate was 10%. In group Ib, the mean age was 60.65±7.37years. Among the study group 66.6% were males, 76.6% were diabetic and 76.6% were hypertensive, The mean pre-operative EF was 46.95±10.26%. The mean bypass time was 130.00±40.06 min and the mean cross clamp time was 97.50±31.22 min. The mortality rate was 10%. In group IIb, the mean age was 54.44±10.18 years. Among the study group 63.3% were males, 56.6% were diabetic and 63.3% were hypertensive, The mean pre-operative EF was 48.55±11.08%. The mean bypass time was 127.77±29.90 min and the mean cross clamp time was 98.88±25.71 min. The IABP was used in 11.7%. The mortality rate was 3.3%. There were significant differences between groups regarding the postoperative degrees of severity of MR (P<0.001). Conclusion: Our preliminary findings showed that there was no significant difference in the surgical outcome of MVR and MVr in terms of early mortality and morbidities. However, mitral valve repair was linked to an increased incidence of residual or recurrent mitral regurgitation. Recent researches suggest the role