Coronary artery bypass grafting combined with mitral valvuloplasty for the treatment of ischemic mitral regurgitation

doi:10.3969/j.issn.1672-5301.2018.03.017

Abstract：Objective The aim of this study was to identify the predictors of early prognoses and survivals in patients with ischemic mitral regurgitation(IMR) who had undergone mitral valvuloplasty(MVP) combined with revascularization.Methods From January 2012 to December 2015,33 patients with IMR who had undergone MVP combined with coronary artery bypass graft(CABG) in our institution were enrolled.Mitral valve annuloplasty rings were used in all patients.Patients' mean age was (58.3±7.7)years,New York Heart Association(NYHA) class Ⅲ or Ⅳ was 51.5％,preoperative left ventricular end-diastolic diameter(LVEDD) was (58.0±4.7)mm and ejection fraction(EF) was (52.3％± 11.4)％.The study endpoints were postoperative death,reoperation,recurrence of moderate or severe mitral regurgitation and heart failure.Results Follow-up data were obtained in all patients.Mean follow-up was (20.3±8.5)months.Preoperative characteristics were comparable between the two groups.Only mitral annular dilatation (AD) was significantly different between the groups (57.9％ vs.30.3％,P=0.02).AD,NYHA class Ⅲ or Ⅳ,ventricular aneurysm (VA) were powerful risk factors of endpoint events on univariate analysis.After adjustments,Cox proportional-hazards regression analysis showed that AD,atrial fibrillation,aortic cross clamp time were the risk factors of early prognoses.Moreover,patients with annular dilatation showed significantly higher rate of endpoint events than those without annular dilatation (HR=5.64,95％CI 1.20-28.05,P＜0.05).Conclusion In patients with IMR,annular dilatation,atrial fibrillation,and long aortic cross clamp time were independent risk factors of early prognoses after MVP combined with CABG.Patients with annular dilatation showed higher rate of endpoint events than those without annular dilatation.