Evaluation of the results of surgical treatment in patients with ischemic heart failure in combination with mitral insufficiency

Introduction. A need for surgical repair of severe ischemic mitral regurgitation (MR) is not doubted, while surgical intervention for mild MR is debatable because of its possible advantages and complications. An additional problem is the necessity of simultaneous repair of a closing function of the mitral valve (MV) and surgical ventricular reconstruction (SVR). Objectives. The study evaluates mortality rate of the patients with ischemic heart disease and heart failure (HF) combined with MR after surgical treatment and the impact of different approaches to surgical treatment on the cardiac function in the early and mid-term postoperative periods. Methods. 95 patients with significant HF and ischemic MR surgically treated over a period from 2009 to 2013 were included in the study. While using instrumental and post-biopsy morphological methods as the first stage, we compared the patients died in the perioperative period with those who were discharged from the hospital after surgical treatment. As the second stage, the survived patients were divided into two groups depending on whether SVR was performed during the surgery. At 1 and 12 months both patient groups were examined by means of EchoCG, MRI and bicycle ergometry. Results. According to the post-biopsy morphological study data, unfavorable prognosis, such as early postoperative mortality in patients with HF and ischemic MR, may be associated with the intraoperative CPB time, functional class of chronic HF before the surgery, patient age, lowered parenchyma-stromal ratio of the left ventricular wall myocardium. SVR performed together with CABG and MV function repair contribute to the maintenance of LV sphericity index and positive dynamics of VO 2max, with all other mid-term postoperative characteristics unchangeable, which is indicative of growing energy capacity of the heart and its increasing pumping efficiency. Conclusions. The study shows the relationship of mortality risk in the early postoperative period and patients’ clinical data. The pumping efficiency of the heart of patients who underwent SVR in a year after surgery is proven to be better than that of patients without SVR.