One-year outcomes of concomitant mitral reduction annuloplasty repair with coronary artery bypass grafting for moderate ischemic mitral regurgitation

Abstract

Background

Mitral valve repair for chronic ischemic mitral regurgitation (IMR) in the published literature has contradictory outcomes. Here, we report our center outcomes of reduction annuloplasty technique in addition to myocardial revascularization to treat ischemic IMR over a four-year period.

Methods

Between January 2011 and December 2014, a total of 40 patients were identified to have a reduced left ventricular ejection fraction who underwent first-time mitral valve reduction annuloplasty concomitantly with coronary artery bypass grafting to treat moderate IMR. Variations in left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), functional class, and mitral regurgitation (MR) was followed up after surgery and retrospectively analyzed.

Results

In our cohort, mitral reduction annuloplasty was successful in helping 33 (82%) patients to have no residual MR and to downgrade their MR from moderate (grade 3+) to trace (grade 1+) in 7 (18%) patients before leaving the operating room. A change from baseline value was observed secondary to correction of MR. At 3-months follow-up time; the mean MR grade that was 0.2 ± 0.1 by the intraoperative assessment post-bypass has increased significantly to be 1.8 ± 0.4 (p < 0.05). Similarly, at one year after surgery it increased to 1.9 ± 0.3, p < 0.05, compared to baseline value.

Remarkably, our patients showed a significant increase in the mean LVEF (48 ± 1.1%, p < 0.05), at 3-month visit and 1-year visit post-surgery (47 ± 4.2%), %, p < 0.05) compared to the baseline values (39 ± 2.3%, p < 0.05 for both visits). While our patients showed gradually but non-significantly reduction in the mean LVESVI (57.6 ± 9.0 ml/m², p > 0.05) at early follow-up time, mean LVESVI improved significantly to be 47.6 ± 11.0 ml/m², p < 0.05 at the one year. This statistically significant increase in the LVEF% at 3-month visit, in addition to the reduction in the LVESVI after one year were capable to induce substantial clinical change in NYHA functional class, which was observed early (at 3-month visit) where 35 (88%) patients became in NYHA class I and II and later (at 1-year visit post-surgery) where 32 (80%) patients stayed in NYHA class I and II.

No deaths were reported during the one-year follow-up resulting in 95% survival rate. During the one-year follow-up time, 7 (18%) were readmitted to the hospital due to non-cardiac indications.

Early operative mortality (within 30 days after surgery) was 5%. One-year survival was 95%. The mean duration of follow-up was 1.1 ± 2.4 years (range, 1.0–3.5 years).

Conclusions

Mitral reduction annuloplasty concomitant to surgical myocardial revascularization may be sufficient to correct moderate IMR. It is associated with substantial improvement in early and intermediate-term survival rates, left ventricular functions, NYHA class and low incidence of recurrent MR.