33. Moderate ischemic mitral regurgitation: Revascularization alone versus revascularization and mitral valve repair

Abstract

Ischemic mitral regurgitation (IMR) can be defined as mitral valve (MV) insufficiency caused by coronary artery disease and excluding other causes of mitral pathology as rheumatic, myxomatous, infectious, congenital, or connective tissue diseases ,it usually occurs with right or circumflex coronary infarction that involves the posterior ventricular wall, posterior papillary muscle, and adjacent mitral annulus (1). The management of IMR represents a therapeutic challenge. Although most patients are treated medically, many patients are referred for surgery. Some authors claimed that revascularization alone is sufficient for managing those patients (3), whereas others have recommended revascularization combined with mitral valve repair (2). There is a general agreement that patients with mild mitral regurge (1+) are treated with coronary artery bypass surgery (CABG) alone and those with severe (3+ or 4+) IMR should undergo mitral valve surgery at the time of CABG surgery. However, the importance of moderate IMR (2+) is still controversial. A prospective controlled randomized study includes (60 patients with IHD undergoing CABG with ischemic mitral regurge aged from 40 to 65 years of both sexes). They will be divided into two groups of patients: Group I: 30 patients with IHD and moderate IMR undergoing on pump CABG for revascularization only. Group II: A 30 patients with IHD and moderate IMR undergoing on pump CABG for revascularization and mitral valve repair. Study made from January, 2014 to August, 2015, at Medina Cardiac Centre that the presence of moderate (2+) ischaemic mitral regurgitation in ischaemic heart disease patients undergoing revascularization alone does not add any additional burden to the operative risk nor does it affect the immediate and early outcome of these patients. That revascularization alone can ameliorate moderate ischaemic mitral regurgitation in most patients postoperatively. This improvement is translated into an improvement in the functional class and the quality of life postoperatively there is no statistical difference between two groups.Also a procedure to address the mitral valve in moderate IMR should be considered in patients with a worse preoperative left ventricular profile.