Mitral valve annuloplasty and myocardial revascularization in the treatment of mitral regurgitation secondary to coronary artery disease

Objectives: After myocardial infarction (MI) a remodelling process leads to abnormalities in left ventricular (LV) volume, function, and shape, which, in presence of a normal valve, leads to mitral regurgitation (MR), worsening patient s prognosis. The aim of this study is to examine perioperative mortality and morbidity in patients operated on coronary by-pass graft (CABG) and mitral valve annuloplasty, to review actual indications to surgery, and to discuss recent improvements in the operative management of this kind of patients. Methods: 191 patients were operated of CABG and mitral annuloplasty from January 1999 and December 2003. Each patient, before surgery, underwent coronary angiography and echocardiography. Patients eligible for revascularization that presented at echocardiography a mild or more severe mitral valve regurgitation (ERO>0.2cm2) were considered for annuloplasty with Cosgrove ring combined to CABG. Majority were male 149 (78%) with a mean age of 66.4 years. EUROscore resulted >6 in 45 patients, with a mean of 4.6. EF < 35% was present in 25% of patients. Mean number of grafts anastomoses was 2,3 (range 1-3). Left internal mammary artery (LIMA) was used in the majority of patients (162), and a complete arterial revascularization was performed in 16 patients. Results: In-hospital mortality was 2.7% (8 patients), due to perioperative AMI in 3 patients, untreatable cardiac failure in 3 and MOF in 2 patients. Mean I.C.U. time was 3.2 days. The follow up was based on phone interview and consequent ambulatory clinical and echocardiographic controls. Conclusions: In our experience combined CABG and ring annuloplasty for ischemic MR carries low risks for in-hospital mortality and morbidity. Clinical and echocardiographic midterm follow-up is in progress and these related data will be presented and discussed in detail during the congress sessions.