Surgical Approach to Moderate to Severe Ischemic Mitral Regurgitation Following the First Myocardial Infarction

Objectives: Ischemic mitral valve regurgitation (IMR) is a subgroup of secondary mitral valve insufficiency that develops due to ischemic heart disease. The aim of the study is to evaluate the patients who were operated after acute myocardial infarction (AMI) for the type of interventions to be performed for the mitral valve in terms of mortality and morbidity. Methods: Patients who were admitted to the hospital with the diagnosis of acute myocardial infarction and operated emergently or urgently between January 2017 and December 2020 were evaluated. Echocardiographic quantitative and qualitative data were measured. Accordingly, patients were evaluated as mild, moderate or severe mitral insufficiency. Patients who were found to have significant IMR (≥ moderate mitral regurgitation) in the early period and who could achieve complete revascularization were included in the study. Patients were divided into two groups whether the mitral valve was intervened or not. Results: The demographical data of the patients that were included in the study is as follows, 73.4% were male and 33% were female. The average age of the patients was 63.2±8.9. Patients were compared in terms of significant postoperative residual mitral regurgitation. 62.2% (n=23) of the patients undergone isolated CABG had mild mitral regurgitation. 5 patients with mitral valve annuloplasty (17.9%) had significant residual regurgitation (p<0.001). Conclusion: Mitral valve intervention should not be considered in non-severe mitral valve insufficiencies (without papillary rupture or chorda rupture) after AMI. The higher incidence of insufficiency after the use of isolated mitral annular ring due to left ventricular remodeling makes mitral annular ring less of a treatment option in the acute process.