Application Of Coronary Artery Bypass Grafting Combined With Mitral Valve Surgery In The Treatment Of Coronary Heart Disease With Moderate Ischemic Mitral Regurgitation

BackgroundIschemic mitral regurgitation?IMR?is a common complication in coronary heart disease.The epidemiological studies show that the incidence of IMR accounts for about 12%to 34.6%in the general population,and the moderate andsevere patients account for about 2%to4.3%^[1,2].In the early acute myocardial infarction,13%to 55%of these patients have IMR and 2%to 19%among them develop into moderate or higher IMR with the progress of the course^[3-5].Mitral regurgitation?MR?is now considered an independent risk factor for patients with poor prognosis^[3-7].For moderate or more serious IMR,current guidelines has achieved consensus that treatment of the simultaneous mitral valve surgery on coronary artery bypass grafting?CABG?^[8-10],but whether moderate IMR can benefit from CABG alone or combined with mitral valve surgery remains controversial^[8-10].According to the the short term follow-up after surgery,the recurrence rate of MR can reach more than 20%,and it is higher in CABG alone^[11].It needs further study of the effect that mitral valve surgical strategies during coronary revascularization on MR recurrence?persistent or aggravated?for a considerable proportion of MR recurrence after surgery.And whether these benefits can reach consensus or not requires more clinical evidence and also needs longer follow-up results to support.ObjectiveTo explore the feasiblity of surgical strategies for IMR and influences of ischemic mitral regurgitation improvement after surgery by analyzing the medium and long term results of patients with moderate ischemic mitral regurgitation who underwent combined mitral valve surgery with coronary artery bypass grafting compare with CABG alone.MethodsBy analyzing the clinical data and follow-up results of 62 patients diagnosed with moderate IMR who had been operated from January2012 to December 2017 in the Seventh People's Hospital of Zhengzhou,divided into two groups.Group A including CABG alone in 49 cases and B combined mitral valve repair operation?CABG+MVP?in 13 cases.There were 32 males and 17 females in A Group.8 males and 5 females in group B.Based on the data,such as pre-operative general clinical data,peri-operative affairs and follow-up results after operation,weanalyze statistical differences by t-test,?²-testand Mann-Whitney U test,etc.Results1.There was of no significant differences between the two groups in age,gender,area of the myocardial infarction,previous PCI?percutaneous coronary intervention?,remote cerebral infarction,hypertension,diabetes,etc?P>0.05?.2.The statistical differences is not significant?P>0.05?in these aspects,such as the vessels number of bypass grafting,combined with other surgeries?resection of ventricular aneurysm,etc.?,mechanicalventilation time and occurrence of secondary thoracotomy,malignant arrhythmia,LCOS?low cardiac output syndrome?,respiratory insufficiency,recurrent MR and hospital death,ect.in both groups of patients.3.The grading of left ventricular end-diastolic diameter?LVEDD?,left ventricular end-diastolic volume?LVEDV?at 3months,12 months and 24 months after operation is improved compared with that before operation,with statistically significant changes?P<0.05?in two groups,but the change of left ventricular ejection fraction?LVEF?were not statistically significant?P>0.05?.The incidence of recurrent MR in group A was higher than in B?20.4%vs.15.4%,P>0.05?within one week after surgery.However,the incidence of MR in the group B is lower?18.2%vs.36.5%,P<0.05?at 24 months after operation and it has statistical differences.There was no difference in NYHA cardiac function class before operation between the two groups?P>0.05?,the group B was better than A?P<0.05?follow-up at 24 months.The mortality?P>0.05?and incidence of?major adverse cardiac events?MACCEs?P>0.05?in terms of group A to B were not statistically significant.4.Multiple regression analysis showed that acute myocardial infarction,LVEDD?65mm,NYHA cardiac class??were the factors of influencing patient's MR recurrence after operation.Conclusions1.The application of coronary artery bypass grafting combined with mitral valve surgery in treatment of moderate IMR has lower probability of recur MR,without significantly increase of the MACCEs such as stroke in the medium and longterm,with the similar rate of complications,showing stability and long-term under the principle of sufficient revascularization.The efficacy are reliable.2.For patients with LVEDD?65mm,acute myocardial infarction and NYHA cardiac class??,which is a factor affecting the improvement of MR,the recurrent MR is higher after surgery.