Consequence Of Moderate Ischemic Mitral Regurgitation After Isolated Coronary Artery Bypass Grafting In Patients With Low Ejection Fraction
Hiroyuki Nakajima, Akitoshi Takazawa, Masatoshi Akiyama, Akihiro Yoshitake, Toshihisa Asakura, Tomomi Nakajima.
Saitama Medical University, International Medical Center, Saitama, Japan.
BACKGROUND: Ischemic mitral regurgitation (IMR) is a predictor of adverse cardiac events after coronary artery bypass grafting (CABG). Patients’ selection for mitral valve procedure concomitant with CABG may be crucial, especially in the era of off-pump surgery. The aim of this study was to delineate the impact of isolated CABG on moderate IMR. METHODS: We retrospectively reviewed clinical records of 41 patients who had moderate IMR with ejection fraction (EF) < 35%, and underwent isolated CABG between since 2007. Off-pump CABG was performed in 37/41(90%). M:F = 29:12. These patients were divided to three groups. Group A(acute) consisted of 10 patients who were within a month after the onset of acute coronary syndrome or myocardial infarction (ACS/MI). Group S(subacute) consisted of 12 patients who were within 6 months after initial episode of congestive heart failure(HF). Group C(chronic) included remaining 19 patients. Improvement of IMR was defined as mild or less at latest postoperative echocardiography. Interval between CABG and latest echocardiography was 6.3 ± 10.8 months.
RESULTS: In group A, IMR was improved in 7(70%) patients, while IMR worsened to severe in 3 (30%) due to progression of tethering, postoperatively. There was no significant difference in EF, location of asynergy and Q wave, dimension of left ventricle and coaptation depth, and interval between ACS/MI and CABG between patients with improvement of IMR and those without. Of 12 patients in group S, improvement was found in 10(83%) patients. Of 3 patients whose interval between initial HF and CABG was 3 months or more, 2(67%) patients had moderate IMR postoperatively. In group C, 7(88%) of 8 patients with postoperative moderate IMR had asynergy in RCA region, while all of 5 patients with asynergy in LAD region presented improvement of IMR.
CONCLUSIONS: For moderate IMR with EF<35%, possible candidates for mitral valve procedure may be patients within a month after ACS/MI of RCA region, and those who were 3 month or more after initial HF with asynergy of RCA region. On the contrary, improvement of IMR could highly predicted in patients with asynergy of LAD region, or less than 2 months after initial HF.
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