Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation.

BACKGROUND AND AIM

Ischemic mitral regurgitation (IMR) recurrence after combined coronary artery bypass grafting (CABG) and mitral valve repair does occur, with a prevalence of 20% to 30% at the 2- to 4-year follow-up. This single-center study aims to identify the predictors of IMR improvement after surgical revascularization plus mitral valve repair for moderate IMR.

METHODS

A total of 201 eligible patients were entered into an improved group (n = 141) or a control group (n = 60) according to whether moderate or more mitral regurgitation occurred at the 2-year postoperative time point. Clinical outcomes between groups were compared.

RESULTS

The left ventricular endo-diastolic diameter (LVEDD), type of ring (rigid complete ring), and the use of repair techniques (restrictive annuloplasty associated with subvalvular and/or leaflet repair) were three predictors of IMR improvement after surgery (odds ratio [OR] = 0.921, 95% confidence interval [CI], 0.865-0.976, P = .025; OR = 7.753, 95% CI, 3.168-17.742, P < .001; and OR = 0.168, 95% CI, 0.076-0.423, P = .004, respectively). The cutoff value of the LVEDD was 65 mm with a sensitivity of 80.0% and a specificity of 65.2%. Patients in the improved group compared with those in the control group demonstrated better cumulative survival during a median follow-up of 41.0 months (χ  = 4.559, logrank P = .033) and a reduced ratio of the New York Heart Association class III-IV at the latest follow-up (5.7% vs 38.4%, P < .001).

CONCLUSIONS

An LVEDD of less than 65 mm, the use of a rigid complete ring, and combined restrictive annuloplasty and subvalvular and/or leaflet repair are associated with IMR improvement after CABG plus mitral valve repair for the treatment of moderate IMR; IMR improvement 2 years after surgery is associated with improved midterm outcomes.