Repair Versus Replacement for Ischemic Mitral Regurgitation In Patients Who Underwent Coronary Artery Bypass Grafting Plus Mitral Valve Surgery

Rezumat

Background: Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The optimal management of IMR is controversial. Although practice guidelines advise surgical intervention for patients presenting with a severe form of this condition, they also recognize the limited evidence supporting repair or replacement. Aim of the study: to analyse and compare the early outcomes of mitral valve repair (MVr) versus mitral valve replacement (MVR) with concomitant CABG in patients with IMR. Methods: A retrospective comparative study on 100 patients who underwent concomitant CABG for their coronary artery disease (CAD) and a mitral valve surgery for IMR, either MVr or MVR, between August 2021 and August 2023, at National Heart Institute. The patients were divided into four groups: group I (No=50) who underwent MVr and group II (N=50) who underwent MVR. Results: In group Ia, the mean age was 54.25±10.04 years. Among the study group 75% were males, 70% were diabetic and 60% were hypertensive, The mean pre-operative EF was 50.65±7.66%. The mean bypass time was 120.50±31.86 min and the mean cross clamp time was 94.50±29.28 min. The mortality rate was 5%. In group IIa, the mean age was 53.55±8.88 years. Among the study group 65% were males, 65% were diabetic and 85% were hypertensive. The mean pre-operative EF was 55.75±10.49%. The mean bypass time was 133.44±25.08 min and the mean cross clamp time was107.22±28.84 min. The mortality rate was 10%. In group Ib, the mean age was 60.65±7.37years. Among the study group 66.6% were males, 76.6% were diabetic and 76.6% were hypertensive, The mean pre-operative EF was 46.95±10.26%. The mean bypass time was 130.00±40.06 min and the mean cross clamp time was 97.50±31.22 min. The mortality rate was 10%. In group IIb, the mean age was 54.44±10.18 years. Among the study group 63.3% were males, 56.6% were diabetic and 63.3% were hypertensive, The mean pre-operative EF was 48.55±11.08%. The mean bypass time was 127.77±29.90 min and the mean cross clamp time was 98.88±25.71 min. The IABP was used in 11.7%. The mortality rate was 3.3%. There were significant differences between groups regarding the postoperative degrees of severity of MR (P