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Evaluation of the Results of Surgical Treatment in Ischaemic Mitral Regurgitation

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Wojtasik-Anioł M., Adamek-Kośmider A., Wojtasik L., Jaszewski R.
Polish Journal of Surgery
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2008
|
vol. 80
|
issue 4
209-216
EN
The aim of the study was to assess the results of mitral valve surgery in patients with chronic coronary artery disease, subjected to concomitant coronary artery by-pass grafting (CABG).Material and methods. The study group comprised 24 patients (aged 48-72) with coronary artery disease and significant ischemic mitral regurgitation, who qualified for mitral annuloplasty concomitant with CABG. All patients underwent a review of medical history, NYHA and CCS class evaluation, electrocardiography, transthoracic echocardiography and coronarography. Patients were subjected to intra-operative transesophageal echocardiography; in the early postoperative period their clinical state was assessed and electrocardiography and transthoracic echocardiography were performed. The followup, 6-12 months after the surgery, included history of life comfort, NYHA and CCS class evaluation, electrocardiography and transthoracic echocardiography. Echocardiographic parameters were analyzed using Student's t-test and the STATISTICA 7.1 program.Results. Most patients were qualified into NYHA classes I and II postoperatively, as compared to class II, III or IV before the surgery. According to CCS class, 16 patients were asymptomatic and four were class I. Based on NYHA and CCS classes, patient life comfort was assessed before and after the surgery. Life comfort was improved in 20 patients. An improvement was achieved in all studied echocardiographic parameters, left ventricular ejection fraction, left ventricular end-systolic and diastolic diameters, left atrial diameter, vena contracta, effective regurgitant orifice, regurgitant volume, proximal isovelocity surface area, and regurgitant jet area. Pre- and postoperative mitral regurgitation grades were assessed: 13 patients had grade IV, eight had grade III and three had grade II mitral regurgitation prior to surgery, as compared to trace or grade I in 22 patients after surgery, and grade II in one patient following peri-operative myocardial infarction.Conclusions. Mitral annuloplasty concomitant with CABG significantly improved hemodynamic heart parameters, particularly left ventricular systolic function and ejection fraction, decreased left ventricular and left atrial dimensions, significantly reduced MR grades and improved patient life comfort.
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