Mitral valve repair and isolated coronary artery bypass grafting in ischemic cardiomyopathy and moderate mitral insufficiency

Objectives. The article evaluates the impact of mitral valve repair on mitral regurgitation (MR) dynamics, risk of perioperative mortality and long-term survival of patients with left ventricular ejection fraction less than 35% under the conditions of moderate MR. Methods. The study included 76 patients who were randomized in two groups, with the first group (38 patients) undergoing CABG combined with repair of the mitral valve and the second one (38 patients) having isolated CABG. All patients were examined before surgery, at discharge and during long-term follow-up. Results. The analysis of long-term survival of patients showed the effectiveness of mitral valve repair as compared with isolated CABG. A significant difference in survival was found between the groups in the sixth year of follow-up: survival with CABG was 54% and with CABG + MVR it ran up to 74% in the groups (p = 0.05). The predictors of return MR were identified in patients with moderate IMR and ischemic cardiomyopathy. The factors of progression of MR were found out to be significant when the coarctation depth exceeded 7 mm, inter-papillary distance was 30 mm or more and annulus diameter was in excess of 33 mm. The assessment of predictors of mortality during long-term follow-up revealed a significant impact of heart failure class, pulmonary hypertension and progression of mitral insufficiency.