Repair of Chronic Moderate Ischemic Mitral Regurgitation; Is it Really Needed During Coronary Revascularization?

Aim: The need of the repair of the Chronic Moderate Ischemic Mitral Regurgitation [IMR] during coronary revascularization presents always a question to be answered by the cardiac surgeon and the cardiologist during tailoring the management plan for different patients. We are studying the effect of repairing the chronic moderate IMR during CABO surgery. Methods: We collected all patients who went for CABO and having preoperative chronic moderate IMR 2/4 by 2 D echo evaluation between January 2005 and January 2008. Preoperative data were collected for a total number of 62 patients. The 62 patients were divided in 2 groups: 38 patients who went for combined CABO and mitral valve repair [group A], 24 patients who went for only CABO without any mitral valve intervention [group B]. Follow-up was done by phone calls and outpatient visits and echocardiography in an average period of 20 months [6 to 35 months] from the initial date of surgery. Results: The ischemic time and bypass time was longer and significantly higher in group A. As expected with no surprises due to the addition of the mitral valve repair procedure. The intermediate term follow up [average 20 months after surgery] showed only a statistical difference in the progression to severe IMR 3/4 to 4/4. Progression to severe mitral regurgitation occurred in 3/24 patients [12.5%] in group B. No patient in group A showed moderate to severe Mitral regurgitation after mitral valve repair. Only one patient 1124 in group B showed signs of congestive heart failure needing rehospitalisation [ 4.16% ]. No patient in group A needed rehospitalisation but this data was not statistically significant. Comparison of the other data including left ventricular EF%, LVEDD, mortality were not significant in both groups. Conclusion: Repairing the moderate IMR during coronary revascularization might decrease the progress to severe IMR and the subsequent congestive heart failure. Although the mitral repair did not show any difference in patient survival over 20 months mean period of follow-up.