Key result
Isolated CABG is linked to severe mitral regurgitation progression in ~71% of patients by 36 months.
Why the study?
The comparative surgical outcomes of isolated CABG versus CABG combined with mitral valve repair, as well as the risk factors for recurrent mitral insufficiency, needed evaluation in patients with ischemic cardiomyopathy and moderate ischemic mitral insufficiency.
Cohort (n=76)
No
Answers are grounded in this paper and cite their sources.
May inform risk stratification for MR recurrence after CABG; leaves open need for RCTs to guide MV repair in ischemic cardiomyopathy.
Aim. This study aimed to compare the surgical correction results for isolated coronary artery bypass graft (CABG) and CABG in combination with mitral valve (MV) repair for moderate ischemic mitral insufficiency (IMI) in patients with ischemic cardiomyopathy and to identify the risk factors for MI return.Methods. This single-centre prospective study enrolled 76 patients with ischemic cardiomyopathy and moderate MI with a left ventricular ejection fraction < 35% who did not undergo left ventricular reconstruction. The patients were treated with isolated CABG or CABG in combination with MV repair. The mean age of the patients was 57.5 ± 8.6 years (range, 30–75 years), and 90% were men. Isolated annuloplasty was used with a rigid support ring brand with a ring size of 26–30 mm to correct mitral insufficiency in the CABG + MV repair group.Results. We found that isolated CABG or CABG + MV repair in patients with ischemic heart disease and severe systolic left ventricular dysfunction does not result in significant decrease in the MI in the long term compared with that at baseline. However, the degree of MI after CABG + MV repair is lower than the initial values, unlike that after isolated CABG 12 months postoperatively. In the observation period, of up to 36 months, the MI degree after isolated CABG corresponds to the initial values. The determination of the predictors of IMI progression in ischemic cardiomyopathy enabled us to determine the threshold values of the performance indicators of MV repair, and the evaluation of Echo predictors for annuloplasty preoperatively help select the surgical treatment strategies for patients with ischemic cardiomyopathy and moderate MI.Conclusion. Correction of IMI in patients with ischemic cardiomyopathy does not increase the number of complications in the early postoperative period compared to isolated CABG (p = 0.015). After isolated CABG in patients with ischemic cardiomyopathy and moderate MI, progression of mitral regurgitation (grade 3 mitral regurgitation, initially 0%; after 12 months, 31%; after 36 months, 71%; p < 0.001) is observed even with initially moderate changes in the geometry of the mitral valve.
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Карева et al. (2019) conducted a cohort in Ischemic cardiomyopathy and moderate ischemic mitral insufficiency (n=76). CABG combined with mitral valve repair (isolated annuloplasty with rigid support ring 26-30 mm) vs. Isolated CABG was evaluated on Progression to grade 3 mitral regurgitation at 36 months (p=<0.001). Isolated CABG in ischemic cardiomyopathy with moderate mitral insufficiency resulted in progression to grade 3 mitral regurgitation in 31% at 12 months and 71% at 36 months (p<0.001).
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