Early and long-term outcome of mitral valve repair with a Cosgrove band combined with coronary revascularization in patients with ischemic cardiomyopathy and moderate-severe mitral regurgitation.

BACKGROUND AND AIM OF THE STUDY

Clinical and echocardiographic results were investigated to evaluate mitral valve repair in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy (ICM) with moderately severe mitral regurgitation (MR).

METHODS

A total of 78 patients (21 women, 57 men; mean age 69.5 +/- 7.8 years) with ischemic mitral regurgitation underwent mitral valve repair and CABG. The mean left ventricular ejection fraction (LVEF) was 42.4 +/- 12.4%. Among the patients, 19 (24.4%) had preoperative congestive heart failure (CHF). This surgery constituted a second such operation in five patients (6.4%). The MR was grade 3+ in 28 patients (35.9%) and 4+ in 50 (64.1%). The mean number of grafts was 3.6 per patient.

RESULTS

Hospital mortality was 11.5% (n = 9). Risk factors for early mortality were preoperative NYHA class > or = III (p = 0.014), preoperative heart failure (p <0.001) and reoperation (p = 0.002). The five-year survival was 82.6 +/- 5.9%, and freedom from grade > or =2+ MR was 93.1 +/- 4.1%. Postoperatively, 66 patients (89.6%) were in NYHA class I and seven (9.4%) in class II, demonstrating a statistically significant improvement (p = 0.03). Late echocardiography showed a significant improvement in LVEF (from 42.4 +/- 12.4% to 51.7 +/- 10.9%; p = 0.01) and a reduction in pulmonary artery pressure (from 37.6 +/- 11.9 mmHg to 29.3 +/- 7.4 mmHg; p = 0.004).

CONCLUSION

It is concluded that in patients with ICM, mitral valve repair combined with CABG provides a dramatic improvement in ejection fraction and in CHF, with excellent long-term survival, even in patients with a low LVEF.