Mid-term effect of surgical treatment for moderate to severe ischemic mitral regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Yan ,  TAO Dengshun , WANG Huishan , JIANG Hui , ZHAO Yang , HE Yuanchen , XU Shu , ZHANG Yong , YUE Fengjie

Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

TAO Dengshun, Email: taodengshun@hotmail.com

Keywords：

Ischemic mitral regurgitation; mitral valve surgery; coronary artery bypass grafting; left ventricular remodeling; echocardiography

DOI：

10.7507/1007-4848.202203080

Video：

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Objective To investigate surgical treatment and evaluate the curative effect in patients with moderate to severe ischemic mitral regurgitation (IMR). Methods The clinical data of the patients with coronary heart disease complicated with moderate to severe IMR who agreed to receive surgical treatment from June 2014 to June 2019 in our hospital were analyzed retrospectively. The patients were divided into two groups: a coronary artery bypass grafting (CABG) group and a CABG+mitral valve surgery (MVS) group. The preoperative and postoperative clinical data between the two groups were compared. Results Finally 105 patients were collected, including 75 males and 30 females, aged 40-79 (62.70±7.90) years. There were 34 patients in the CABG group, and 71 patients in the CABG+MVS group including 2 patients of mitral valvuloplasty and 29 patients of mitral valve replacement. Among the 105 patients, 5 died during the perioperative period and 2 died in 3 months after operation, all of whom were from the CABG+MVS group. There was no statistical difference in perioperative and postoperative 3-month mortality rate between the two groups (P=0.14). Eighty-seven patients were followed up in the medium and long term. There was no statistical difference in the degree of preoperative mitral insufficiency (MI) (P=0.59) and left atrium diameter (P=0.51) between the two groups, but the degree of postoperative MI in the CABG group was significantly higher than that in the CABG+MVS group (P<0.01). However, the left atrium diameter in the CABG group was significantly smaller than that in the CABG+MVS group (P<0.01). Paired analysis showed that systolic pulmonary artery pressure, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction and MI were significantly improved after operation (P<0.01); left atrium diameter was significantly improved after operation in the CABG group (P<0.01), but there was no statistical difference before and after operation in the CABG+MVS group (P=0.10). Conclusion For patients with moderate to severe IMR, CABG with mitral valve treatment can improve left ventricular remodeling, but can not significantly improve left atrial remodeling. Whether performing mitral valve treatment during CABG should be cautious. CABG alone is a safe and effective scheme for elderly patients with poor physical condition and low life expectancy.

Citation： JIN Yan, TAO Dengshun, WANG Huishan, JIANG Hui, ZHAO Yang, HE Yuanchen, XU Shu, ZHANG Yong, YUE Fengjie. Mid-term effect of surgical treatment for moderate to severe ischemic mitral regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1714-1719. doi: 10.7507/1007-4848.202203080 Copy

1.	LaPar DJ, Kron IL. Should all ischemic mitral regurgitation be repaired? When should we replace? Curr Opin Cardiol, 2011, 26(2): 113-117.
2.	Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med, 2014, 370(1): 23-32.
3.	He S, Fontaine AA, Schwammenthal E, et al. Integrated mechanism for functional mitral regurgitation: Leaflet restriction versus coapting force: In vitro studies. Circulation, 1997, 96(6): 1826-1834.
4.	Benfari G, Dandale R, Rossi A, et al. Functional mitral regurgitation: Are we treating the real target? J Cardiovasc Med (Hagerstown), 2016, 17(11): 767-773.
5.	Ozawa T, Kawasaki Y, Suenaga E. Coronary artery bypass grafting and mitral annuloplasty in a patient with left ventricular noncompaction with low ejection fraction: Report of a case. Kyobu Geka, 2021, 74(9): 672-675.
6.	Khallaf A, Elzayadi M, Alkady H, et al. Results of coronary artery bypass grafting alone versus combined surgical revascularization and mitral repair in patients with moderate ischemic mitral regurgitation. Heart Surg Forum, 2020, 23(3): E270-E275.
7.	Ferket BS, Thourani VH, Voisine P, et al. Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 2020, 159(6): 2230-2240.
8.	Chen XJ, Liu DX, Huang KL, et al. Interpretation of the American Association for Thoracic Surgery expert consensus document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure in 2021. Zhonghua Yi Xue Za Zhi, 2021, 101(36): 2825-2830.
9.	Teng Z, Ma X, Zhang Q, et al. Additional mitral valve procedure and coronary artery bypass grafting versus isolated coronary artery bypass grafting in the management of significant functional ischemic mitral regurgitation: A meta-analysis. J Cardiovasc Surg (Torino), 2017, 58(1): 121-130.
10.	Dufendach K, Aranda-Michel E, Sultan I, et al. Outcomes of mitral valve surgery for severe ischemic mitral regurgitation. J Card Surg, 2020, 35(2): 390-396.
11.	Wang TKM, Liao YB, Choi D, et al. Mitral valve surgery with or without coronary bypass grafting: Eight-year cohort study. N Z Med J, 2019, 132(1500): 50-58.
12.	金岩, 王辉山, 姜辉, 等. 影响缺血性心肌病血运重建后左心室射血分数的多因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1043-1048.
13.	Min D, Popović ZB. Mitral valve adaptation in ischemic heart disease. J Am Coll Cardiol, 2016, 67(3): 288-290.
14.	Silbiger JJ. Novel pathogenetic mechanisms and structural adaptations in ischemic mitral regurgitation. J Am Soc Echocardiogr, 2013, 26(10): 1107-1117.
15.	张永, 汪曾炜, 陶登顺, 等. 中度缺血性二尖瓣反流外科治疗的近期疗效. 中华胸心血管外科杂志, 2016, 32(6): 340-345.
16.	Salehi M, Bakhshandeh A, Rahmanian M, et al. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction: Excellent early outcome with improved ejection fraction. J Tehran Heart Cent, 2016, 11(1): 6-10.
17.	Zhang H, Liu Y, Qiu S, et al. Short-term and long-term survival after revascularization with or without mitral valve surgery of patients with ischemic mitral valve regurgitation: A meta-analysis. Med Sci Monit, 2015, 21: 3784-3791.
18.	Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
19.	Virk SA, Tian DH, Sriravindrarajah A, et al. Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: Meta-analysis of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg, 2017, 154(1): 127-136.

1. LaPar DJ, Kron IL. Should all ischemic mitral regurgitation be repaired? When should we replace? Curr Opin Cardiol, 2011, 26(2): 113-117.
2. Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med, 2014, 370(1): 23-32.
3. He S, Fontaine AA, Schwammenthal E, et al. Integrated mechanism for functional mitral regurgitation: Leaflet restriction versus coapting force: In vitro studies. Circulation, 1997, 96(6): 1826-1834.
4. Benfari G, Dandale R, Rossi A, et al. Functional mitral regurgitation: Are we treating the real target? J Cardiovasc Med (Hagerstown), 2016, 17(11): 767-773.
5. Ozawa T, Kawasaki Y, Suenaga E. Coronary artery bypass grafting and mitral annuloplasty in a patient with left ventricular noncompaction with low ejection fraction: Report of a case. Kyobu Geka, 2021, 74(9): 672-675.
6. Khallaf A, Elzayadi M, Alkady H, et al. Results of coronary artery bypass grafting alone versus combined surgical revascularization and mitral repair in patients with moderate ischemic mitral regurgitation. Heart Surg Forum, 2020, 23(3): E270-E275.
7. Ferket BS, Thourani VH, Voisine P, et al. Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 2020, 159(6): 2230-2240.
8. Chen XJ, Liu DX, Huang KL, et al. Interpretation of the American Association for Thoracic Surgery expert consensus document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure in 2021. Zhonghua Yi Xue Za Zhi, 2021, 101(36): 2825-2830.
9. Teng Z, Ma X, Zhang Q, et al. Additional mitral valve procedure and coronary artery bypass grafting versus isolated coronary artery bypass grafting in the management of significant functional ischemic mitral regurgitation: A meta-analysis. J Cardiovasc Surg (Torino), 2017, 58(1): 121-130.
10. Dufendach K, Aranda-Michel E, Sultan I, et al. Outcomes of mitral valve surgery for severe ischemic mitral regurgitation. J Card Surg, 2020, 35(2): 390-396.
11. Wang TKM, Liao YB, Choi D, et al. Mitral valve surgery with or without coronary bypass grafting: Eight-year cohort study. N Z Med J, 2019, 132(1500): 50-58.
12. 金岩, 王辉山, 姜辉, 等. 影响缺血性心肌病血运重建后左心室射血分数的多因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1043-1048.
13. Min D, Popović ZB. Mitral valve adaptation in ischemic heart disease. J Am Coll Cardiol, 2016, 67(3): 288-290.
14. Silbiger JJ. Novel pathogenetic mechanisms and structural adaptations in ischemic mitral regurgitation. J Am Soc Echocardiogr, 2013, 26(10): 1107-1117.
15. 张永, 汪曾炜, 陶登顺, 等. 中度缺血性二尖瓣反流外科治疗的近期疗效. 中华胸心血管外科杂志, 2016, 32(6): 340-345.
16. Salehi M, Bakhshandeh A, Rahmanian M, et al. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction: Excellent early outcome with improved ejection fraction. J Tehran Heart Cent, 2016, 11(1): 6-10.
17. Zhang H, Liu Y, Qiu S, et al. Short-term and long-term survival after revascularization with or without mitral valve surgery of patients with ischemic mitral valve regurgitation: A meta-analysis. Med Sci Monit, 2015, 21: 3784-3791.
18. Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
19. Virk SA, Tian DH, Sriravindrarajah A, et al. Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: Meta-analysis of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg, 2017, 154(1): 127-136.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid-term effect of surgical treatment for moderate to severe ischemic mitral regurgitation

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