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Immediate outcomes of surgical treatment for moderate ischemic mitral insufficiency in patients with preserved left ventricular ejection fraction

Chernyavsky A. M., Razumakhin R. A., Ruzmatov T. M., Efendiev V. U., Podsosnikova T. N., Volokitina T. L., Matveeva N. V.

Keywords: left ventricle, mitral insufficiency, preserved ejection fraction, surgical therapy

DOI: 10.18087/rhj.2014.5.1996

Background. Chronic ischemic mitral insufficiency (IMI) remains one of the most complicated and unsolved issues in the tactics for treatment of IHD. Aim. In this article, we provided direct results of comparing the methods of isolated CB and CB with mitral valve (MV) ring annuloplasty in patients with normal or near-normal LV EF. The study was aimed at determination of mitral regurgitation (MR) time course and clinico-functional parameters in patients of both groups postsurgery. Materials and methods. The study included 73 patients. All patients had IHD involving coronary arteries which required coronary bypass, a history of a previous MI at least 30 days ago, and moderate IMI. Group 1 consisted of 33 (45.3 %) patients who have had CB alone; group 2 included 40 (54.7 %) patients who have had CB with MV ring annuloplasty. Mean age of patients was 61.4±7.2 years; 53 (72 %) of these patients were males. Mean LV EF was 45 (38; 53) %. Results. In-hospital mortality (<30 days) and mortality within three months postsurgery were absent in both groups. In the isolated CB group at 3 months of the surgery, mild MR was observed in 12 (36.5 %) patients, moderate MR in 19 (57.5 %), and MR progressing from moderate to severe in two patients (6 %). In the group of CB with MV plasty, mild MR was observed in 21 (52.5 %) patients and MR was absent in 19 (47.5 %) patients. At 3 months postsurgery, the HF FC decreased from 3 (3; 3) to 1 (1; 2) (p=0.00002) in the CB group and from 3 (2; 3) to 0 (0; 1) (p<0.001) in the MV plasty group. Conclusion. The addition of MV plasty to CB considerably reduced the severity of moderate IMR immediately after the surgery and completely eliminated it practically in half of cases. Both methods statistically significantly improved the clinical condition of patients in the remote period.
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Chernyavsky A. M., Razumakhin R. A., Ruzmatov T. M. et al. Immediate outcomes of surgical treatment for moderate ischemic mitral insufficiency in patients with preserved left ventricular ejection fraction. Russian Heart Journal. 2014;79 (5):317–323

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