Journal of Shanghai Jiao Tong University (Medical Science) >

2022 , Vol. 42 >Issue 5: 629 - 634

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.05.011

Clinical research

Surgical treatment of moderate ischemic mitral regurgitation complicated with reduced left ventricular ejection fraction

  • Haoyi YAO ,
  • Yun LIU ,
  • Kaijie QIN ,
  • Mi ZHOU ,
  • Zhe WANG ,
  • Anqing CHEN ,
  • Qiang ZHAO ,
  • Haiqing LI
Expand
  • Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
LI Haiqing, E-mail；drlihaiqing@163.com.

Received date: 2021-11-29

  Accepted date: 2022-04-28

  Online published: 2022-05-28

Fold

Abstract

Objective

·To explore different surgical strategies in patients of moderate ischemic mitral regurgitation (IMR) complicated with reduced left ventricular ejection fraction (LVEF).

Methods

·From May 2013 to May 2019, 31 patients diagnosed as moderate IMR with LVEF <50% received surgical treatment in Department of Cardiovascular Surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into off-pump coronary artery bypass grafting (OPCABG) group and CABG+mitral valve plasty (MVP) group according to whether or not mitral valve procedure was performed. Preoperative, postoperative and follow-up echocardiography data and perioperative complications were compared to evaluate the surgical efficacy.

Results

·There were 12 patients in OPCABG group and 19 patients in CABG+MVP group. 1 patient died in CABG+MVP group postoperatively, which showed no significant difference in mortality (5.3% vs 0) between the groups. The degree of mitral regurgitation was significantly reduced in CABG+MVP group (P=0.000), while intensive care unit (ICU) length of stay significantly increased [3.0 (1.0, 4.0) d vs 1.0 (1.0, 2.0) d, P=0.027]. After 48.7 (30.2, 66.5) months of follow-up, there were no significant differences in mortality, degree of mitral regurgitation, LVEF and complications between the two groups.

Conclusion

·OPCABG procedure treating chronic moderate IMR with reduced LVEF could be beneficial for enhanced recovery after surgery and has satisfactory early and mid-term efficacy.

Key words： ischemic mitral regurgitation; reduced left ventricular ejection fraction; off-pump coronary artery bypass grafting; mitral valve annuloplasty; enhanced recovery after surgery

Cite this article

Haoyi YAO , Yun LIU , Kaijie QIN , Mi ZHOU , Zhe WANG , Anqing CHEN , Qiang ZHAO , Haiqing LI . Surgical treatment of moderate ischemic mitral regurgitation complicated with reduced left ventricular ejection fraction[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022 , 42(5) : 629 -634 . DOI: 10.3969/j.issn.1674-8115.2022.05.011

References

1 ARONSON D, GOLDSHER N, ZUKERMANN R, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction[J]. Arch Intern Med, 2006, 166(21): 2362-2368.
2 HUNG J W. Ischemic (functional) mitral regurgitation[J]. Cardiol Clin, 2013, 31(2): 231-236.
3 MERIS A, AMIGONI M, VERMA A, et al. Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction[J]. J Am Soc Echocardiogr, 2012, 25(5): 535-542.
4 SHARMA H, RADHAKRISHNAN A, NIGHTINGALE P, et al. Mitral regurgitation following acute myocardial infarction treated by percutaneous coronary intervention-prevalence, risk factors, and predictors of outcome[J]. Am J Cardiol, 2021, 157: 22-32.
5 AMIGONI M, MERIS A, THUNE JJ, et al. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function[J]. Eur Heart J, 2007, 28(3): 326-333.
6 NEUMANN F J, SOUSA-UVA M, AHLSSON A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J, 2019, 40(2): 87-165.
7 VAHANIAN A, BEYERSDORF F, PRAZ F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur Heart J, 2022, 43(7): 561-632.
8 BAKAEEN F G, GAUDINO M, WHITMAN G, et al. 2021: The American Association for Thoracic Surgery Expert Consensus Document: coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure[J]. J Thorac Cardiovasc Surg, 2021, 162(3): 829-850.e1.
9 HICKS K A, TCHENG J E, BOZKURT B, et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American college of cardiology/American heart association task force on clinical data standards (writing committee to develop cardiovascular endpoints data standards)[J]. J Am Coll Cardiol, 2015, 66(4): 403-469.
10 Ministry of Health of the People's Republic of China. Diagnostic standard of Hospital Acquired Infection (for Trial Implementation)[J]. Natl Med J China, 2001, 81(5): 314-320.
11 NADIM M K, FORNI L G, BIHORAC A, et al. Cardiac and vascular surgery-associated acute kidney injury: the 20th international consensus conference of the ADQI (acute disease quality initiative) group[J]. J Am Heart Assoc, 2018, 7(11): e008834.
12 PIéRARD L A, CARABELLO B A. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment[J]. Eur Heart J, 2010, 31(24): 2996-3005.
13 DAL-BIANCO J P, LEVINE R A. Anatomy of the mitral valve apparatus[J]. Cardiol Clin, 2013, 31(2): 151-164.
14 KUMANOHOSO T, OTSUJI Y, YOSHIFUKU S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction[J]. J Thorac Cardiovasc Surg, 2003, 125(1): 135-143.
15 COMIN-COLET J, SáNCHEZ-CORRAL M A, MANITO N, et al. Effect of carvedilol therapy on functional mitral regurgitation, ventricular remodeling, and contractility in patients with heart failure due to left ventricular systolic dysfunction[J]. Transplant Proc, 2002, 34(1): 177-178.
16 PONIKOWSKI P, VOORS A A, ANKER S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur J Heart Fail, 2016, 18(8): 891-975.
17 KANG D H, PARK S J, SHIN S H, et al. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation[J]. Circulation, 2019, 139(11): 1354-1365.
18 CLELAND J G, ABRAHAM W T, LINDE C, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure[J]. Eur Heart J, 2013, 34(46): 3547-3556.
19 SUN H, GUAN Y Q, WANG L, et al. Influence of diabetes on cardiac resynchronization therapy in heart failure patients: a meta-analysis[J]. BMC Cardiovasc Disord, 2015, 15: 25.
20 AKLOG L, FILSOUFI F, FLORES K Q, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? [J]. Circulation, 2001, 104(12 Suppl 1): I68-I75.
21 FATTOUCH K, GUCCIONE F, SAMPOGNARO R, et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial[J]. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
22 CHAN K M J, PUNJABI P P, FLATHER M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial[J]. Circulation, 2012, 126(21): 2502-2510.
23 BOUCHARD D, JENSEN H, CARRIER M, et al. Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation[J]. J Thorac Cardiovasc Surg, 2014, 147(5): 1471-1477.
24 MICHLER R E, SMITH P K, PARIDES M K, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation[J]. N Engl J Med, 2016, 374(20): 1932-1941.
Options
Outlines

/

〈 〉