Analysis Of Therapeutic Effect Of Different Surgical Procedures For Moderate Ischemic Mitral Insufficiency

Objective:To compare the clinical features of different surgical programs in the treatment of moderate ischemic mitral regurgitation(IMR)and the risk factors of poor prognosis after surgery of ischemic mitral regurgitation(IMR)and analyze the risk factors of nonimprovement of mitral regurgitation after surgery of CABG alone.Methods:Patients with moderate IMR who underwent surgical treatment in the Department of Cardiac surgery,Affiliated Hospital of Qingdao University from January 1,2013 to January 1,2022 were retrospectively collected and divided into CABG group and CABG+ mitral valve surgery(MVS)group according to surgical methods to analyze the preoperative and postoperative clinical characteristics of the two groups.Logistic regression analysis was carried out according to whether death,heart failure or myocardial infarction occurred during the 1 year follow-up.In addition,Logistic regression analysis was performed to determine whether mitral regurgitation improved in the single CABG group 1 year after surgery.Results:1.A total of 137 patients with moderate ischemic mitral insufficiency were included after meeting the exclusion criteria,of which 98 patients(71.5%)were in the CABG group and 39 patients(28.5%)were in the CABG+MVS group.In this study,there were84 males(61.3%)and 53 females(38.7%).2.The operation time,intraoperative blood loss,postoperative hospital stay,postoperative ICU time and postoperative ventilator time in CABG+MVS group were significantly higher than those in CABG+MVS group(all P<0.05).There was no significant difference between the two groups in the proportion of postoperative IABP implantation,thoracic puncture,and adverse prognosis such as myocardial infarction,heart failure and death after 1 year of follow-up(all P>0.05).Compared with CABG+MVS group,LVEF(left ventricular ejection fraction(LVEF)and PASP(pulmonary artery pressure)of patients in CABG group 1 year after surgery were compared with those in CABG +MVS group.PASP and LAD improved significantly from baseline values(all P<0.05).3.Multivariate Logistic regression analysis showed that the history of cerebral infarction(OR=7.708,95%CI 1.917-31.000,P=0.004),LVEF(OR=0.955,95%CI0.912-0.999,P=0.045)was an independent factor for poor prognosis in patients with moderate IMR.4.In patients with simple CABG,multivariate Logistic regression analysis showed LAD(OR=5.018,95%CI 1.509-16.682,P=0.008),right coronary artery occlusion(OR=10.145,95%CI 2.401-42.872,P=0.002)was an independent factor that showed no improvement in mitral regurgitation after CABG alone in patients with moderate IMR.Conclusion:1.In the mid-term follow-up of patients with moderate IMR,CABG alone has a significant advantage in improving cardiac function and preventing cardiac remodeling.History of cerebral infarction and low baseline LVEF are risk factors for poor medium-term prognosis in patients with moderate IMR,and the surgical method is independent of the prognosis.2.Right coronary artery occlusion and increased LAD were independent risk factors for non-improvement of postoperative reflux after CABG.