Results of Reconstructive Surgery of Ischemic Mitral Regurgitation – Immediate and Long-term Outcome

Alexander Vavilov, Inessa Slivneva, Mikhail Latyshev, Pavel Kakhktsyan, Ivan Scopin

Bakulev National Medical Researh Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective.The analysis of immediate and long-term results of surgical treatment in patients with CAD and concomitant mitral regurgitation of an ischemic genesis.

Methods. Research included 64 patients with CAD aged from 33 to 74 years operated from 2010 to 2017. The majority of patients had III (83,5%) and IV (14,9%) functional class according NYHA classification. Average logistic EuroScorewas 6,28. The most part of patients had a dilatation of a left ventricle. 19% of patients had symptoms of LV systolic dysfunction (EF<50%) against a significant mitral regurgitation. All patients had severe MR. In all cases, CABG and MV repair was performed.

Results. The patients were divided into 3 groups according to Carpentier functional classification: 7 patients had isolated annulodilatation (type I), 20 patients – excessive mobility of the leaflets (type II), 37 patients - limitation mobility of the leaflets (type IIIb). In all cases, with the aim of over-correction was implanted semi-rigid annuloplasty ring 26 to 32 size. Hospital mortality rate was 7,8% (n = 5). The main causes of deaths were heart and multiple organ failure.

Conclusion. Ischemic mitral regurgitation can be primary (type II Carpentier) and secondary (type I and IIIb). True ischemic mitral regurgitation is considered as a chronic process resulting from myocardial damage is directly dependent on LV dysfunction and remodeling. The type of reconstructive intervention on the mitral valve and subvalvular structures in patients with ischemic mitral regurgitation depends on the anatomy of all structures of the mitral valve and functional status of the myocardium.