Key result
Combined coronary artery bypass grafting and mitral valve downsizing in patients with ischemic mitral regurgitation and advanced cardiomyopathy resulted in 1.6% early mortality and 83% 2-year survival.
Why the study?
Does combined CABG and mitral valve downsizing improve myocardial function and survival in patients with ischemic mitral regurgitation and advanced cardiomyopathy?
Cohort (n=63)
Does combined CABG and mitral valve downsizing improve myocardial function and survival in patients with ischemic mitral regurgitation and advanced cardiomyopathy?
Combined CABG and restrictive mitral valve annuloplasty in patients with advanced ischemic cardiomyopathy and severe ischemic mitral regurgitation is associated with low mortality and significant reverse remodeling.
Supports combined CABG and mitral downsizing in selected patients; leaves open need for RCTs to confirm survival benefit.
OBJECTIVE: At present not much data is available on changes in myocardial function after combined coronary artery bypass grafting (CABG) and downsizing of the mitral valve (MV) by restrictive prosthetic ring annuloplasty in patients with chronic ischemic mitral regurgitation (IMR) and advanced cardiomyopathy. METHODS: 63 patients with coronary artery disease, chronic IMR grade 3 - 4+, ischemic cardiomyopathy and reduced left ventricular (LV) function (LV ejection fraction [LVEF] of 30 +/- 9 %; range 12 - 45 %) underwent combined CABG and MV downsizing. Clinical follow-up and serial echocardiographic studies were performed to assess survival, New York Heart Association (NYHA) class, mitral regurgitation (MR), leaflet coaptation height (LCH), left atrial (LA) and LV end-systolic/end-diastolic dimensions/volumes and volume indices (LVESD, -EDD; LVESV, -EDV; LVESVI, -EDVI), fractional shortening (FS) and LVEF to evaluate the changes in myocardial function after surgery. RESULTS: Early mortality (< 30 days) was 1.6 %, survival at follow-up was 95 % (3 +/- 1 months) and 83 % (2 +/- 1 years), respectively. Functional class improved significantly after surgery; recurrence of relevant MR was absent in all patients. In general, LA/LV dimensions/volumes and volume indices, FS and LVEF improved significantly, even in patients with already severely reduced preoperative LV function (LVEF </= 25 %, n = 23), a significant improvement of myocardial function was observed. CONCLUSION: Combined MV downsizing and CABG surgery can be performed with low early and late mortality, resulting in a significant improvement of myocardial function and without MR recurrence at short-term and mid-term follow-up.
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Geidel et al. (2007) conducted a cohort in Ischemic mitral regurgitation and advanced cardiomyopathy (n=63). Combined coronary artery bypass grafting and mitral valve downsizing was evaluated on Early mortality (< 30 days). Combined coronary artery bypass grafting and mitral valve downsizing in patients with ischemic mitral regurgitation and advanced cardiomyopathy resulted in 1.6% early mortality and 83% 2-year survival.
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