| Ischemic mitral regurgitation(IMR)is due to the modification of the left ventricle caused after myocardial infarction.As one of the common complications with poor prognosis,Ischemic mitral regurgitation is the main independent risk factor of the clinical prognosis,which significantly increased the risk of cardiovascular events and mortality in patients with myocardial infarction.The mechanism is complex and the surgical treatment remains controversial.The study aims at evaluating the surgical treatment of moderate ischemic mitral regurgitation with coronary artery bypass grafting(CABG)alone or CABG combined mitral valve annuloplasty(MVP)and severe ischemic mitral regurgitation with CABG combined MVP or mitral valve replacement(MVR)for further understanding ischemic mitral regurgitation about the effects of the surgical therapy,and finding out the risk factors for short-term survival.Objectives 1.To evaluate the short-term outcome of MVP in the treatment of moderate IMR patients with CABG.2.To evaluate the short-term outcome of MVP or MVR in treatment of severe IMR patients with CABG.3.To explore the risk factors of the surgical treatment of moderate and severe IMR patients.Methods Data from 108 cases of moderate patients who were performed with CABG alone or CABG and severe IMR patients who were performed with MVP or MVR from June 2013 to June 2015,61 cases in moderate IMR(34 cases in CABG group,27 cases in CAGB combined MVP group)and 47 cases in severe IMR(25 cases in MVP group and 22 cases in MVR group).The postoperative major cardiac cerebral vascular events and left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)were recorded.Results 1.There is no significant difference between two groups in the preoperative data(P>0.05).The mortality rate was 4.9%(3/61),one case(1.6%)died in CABG group,2 caces(3.3%)died in the combined surgery group.The average follow-up was 12 months,3 cases of late death(2 cases in CABG group,one case in CABG+MVP group),the cumulative survival rate(P=0.756)was not statistically different.The degree of mitral regurgitation(P<0.01)was significantly decreased in the combined surgery group.NYHA heart function classification was significantly improved(P<0.001).Compared with the preoperative state,the two groups of left ventricular remodeling indicators,such as LVEF,LVESD,LVEDD were not significantly improved(P>0.05),but the difference between two groups was not significant(P>0.05).2.Four patients died in the hospital,the reminding patients were followed up for 12 months,5 cases died.The cumulative survival rate(P=0.885)and the major cardiac cerebral vascular events(P>0.05)were not significantly different.There was nosignificantly change in LVEF,but LVEDD,LVESD and s PAP improved significantly(P<0.05),and there was no difference between the groups(P>0.05).In the MVP group,the postoperative moderate or severe mitral regurgitation patients were significantly less than that in the MVR group(P<0.05).3.The overall rate of mortality was 13.9%.On univariate analysis,the predictors of early mortality were age(OR 1.05,95%CI 1.01-1.12,P=0.031),LVEF<0.35(OR 1.89,95%CI 1.38-4.6,P=0.011).Multivariable analysis showed that LVEF<0.35(OR 2.12 95%CI 1.52-6.71,P=0.035)was independently associated with early mortality.Conclusions 1.MVP can correct the mitral regurgitation of moderate IMR effectively,but CABG combined with MVP cannot bring more benefits in the reversal of improving the left dysfunction and short-term survival,but long-term efficacy remains to be observed.2.The short-term survival rate,reversal of left ventricular remodeling and major cardiac cerebral vascular events of CABG combined with MVP were not significantly different compared with CABG combined with MVR in the treatment of severe IMR,but long-term efficacy remains to be observed.3.The independent risk factor of moderate and severe IMR on early survival is LVEF<0.35(OR 2.12 95%CI 1.52-6.71,P=0.035). |
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