Off-Pump Revascularization in Moderate İschemic Mitral Regurgitation.

Abstract

Background: İschemic mitral regurgitation (IMR) is associated with high mortality and poor outcomes. The surgical management of moderate IMR is still an object of debate.

Methods: Patients with moderate IMR who underwent isolated off pump coronary bypass grafting (OPCAB) with facile stabilization between January 2015 and February 2022 were analyzed. The primary end point was the remaining ischemic mitral regurgitation and echocardiographic findings while the secondary outcomes were defined as mortality, major adverse events and postoperative functional status.

Results: Of 541 patients who underwent isolated OPCAB in this period, there were 62 patients among with concomitant moderate IMR. The mean follow-up period was 19.4±21.6 months. The median number of the coronary anastomosis was 4(range.1-6). In 58.06% (n=36), the regurgitation regressed. Left atrial (LA) diameter significantly decreased postoperatively (p= .040). Increased LA diameter was associated with increased major adverse events (p=.010). Rehospitalization rates were higher in low EF. The postoperative poor functional status(NYHA III-IV) was correlated with increased postoperative left ventricular end-systolic diameter (41.75±6.13 v.s. 34.79±6.8 p=.05). Mortality(4.8%, n=3) was associated with elder age and increased preoperative systolic pulmonary artery pressure (p= .050; p= .046 respectively).

Conclusion: LA diameter, LVESD, mean systolic pulmonary artery pressure, LVEF and age are important predictors for outcomes in IMR. Remaining IMR per se is not directly correlated with increased mortality and MACCE. Facile stabilization technique we use here, is advantegous due to the feasibility of full revascularization of all intended vessels particularly of the inferoposterior wall by providing an excellent vision without compression of the heart.