Experience Of The Management About Ischemic Heartdisease Combained Moderate Mitral Regurgitation

Purpose:To summarize 72 patients diagnosis of ischemic heart disease with moderate mitral regurgitation,summary the surgical effect of coronary artery bypass grafting only or combaind with mitral valve repair(MVR)with the patients with ischemic heart disease with moderate mitral regurgitation. Introduce the experience of such surgical management for the patients with ischemic heart disease with moderate mitral regurgitation and provide the surgical basis for such patients. Methods:To retrospectively analysis of 72 patients with ischemic heart disease complicated by moderate mitral regurgitation from January 2013 to December 2015 in the Department of Cardiovascular Surgery from the No.2 Hospital of Ji Lin university.There are 40 males and 32 females,all the patients were diagnosed with ischemic heart disease by digital subtract coronary artery angiography.All the patients suffered from mitral valve regurgitation at the same time.Among all the patients,there are 9 cases underwent percutaneous coronary stent implantation.Preoperative digital subtract coronary artery angiography showed that 19 cases with left main coronary artery disease and 53 cases with three-vessel disease. The cardiac function(NYHA grade): grade II(52 cases), grade III(16 cases)and grade IV(4 cases). All patients were excluded rheumatic mitral valve disease such as valve leaf curling, thickening according to the doppler echocardiography.Patients managed with coronary artery bypass grafting plus mitral valve repair was defined CABG + MVR group,coronary artery bypass grafting alone was defined CABG group. Anastomasis the left internal mammary artery to the left anterior descending coronary artery. Great saphenous vein was sequentially grafted to right coronary artery, left circumflex and left diagonal branch artery. Observed the dates of degree of valve regurgitation, left ventricular ejection fraction, left ventricular size, left ventricular end diastolic diameter preoperative, intraoperative and postoperative 10 days before discharge, 6 months after surgery. The statistical data were processed by SPSS 19 software with computer,statistical significant difference with P < 0.05. Results:Three patients dead in-hospital. There are 263 anastomosis,an average of 3.66. Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular size(postoperative 10 days before discharge, 6 months after surgery) reduce significantly(P <0.05).Left ventricular ejection fraction is lower than preoperative before discharge, but improved significantly after 6 months compared with the preoperative(P<0.05), none of the patients appeared with premature ventricular extrasystole and ventricular fibrillation before discharge. Rapid atrial fibrillation occurred in 9 cases during perioperative and return to normal before discharge. There was no myocardial infarction and low cardiac output syndrome and other complications. the symptom of angina was disappeared in all patients before discharge. Conculsions:comparing with CABG alone,combined coronary artery bypass grafting and mitral valve repair have no significant on survival,degree of mitral regurgitation,size of left ventricular and EF at short-term follow-up.