Surgical treatment strategy of patients with cad and moderate ischemic mitral regurgitation

Aim: To determine the optimal treatment strategy in patients with coronary artery disease complicated by moderate ischemic mitral regurgitation.

Methods: A total of 80 patients consecutively operated in the Surgical Department of Coronary Artery Disease of the B.V. Petrovsky Russian Scientific Center of Surgery in the period from 2015 to 2022 were included in the study. Of them, 38 patients underwent isolated coronary artery bypass grafting (Group 1) and 42 patients underwent simultaneous coronary artery bypass grafting and mitral valve repair (Group 2). The exclusion criteria were as follows: patients after emergency and repeated surgical interventions, patients operated for postinfarction left ventricular aneurysm.

Results: No significant differences in the perioperative parameters were found in the early postoperative period. There were no deaths in both groups. The most common postoperative complications included respiratory failure (15.8% in Group 1 vs. 23.8% in Group 2, p> 0.05) and arrhythmia (18.4% in Group 1 vs. 28.6% in Group 2, p> 0.05). There were no significant differences in the 7-year survival rate between the groups (94.7% in Group 1 vs. 95% in Group 2, p> 0.05). The freedom from adverse cardiac events did not differ significant as well (53% in Group 1 vs. 66.7% in Group 2, p> 0.05).

Conclusion: A personalized approach based on the quantitative and qualitative assessment of the individual patient status, intracardiac hemodynamic parameters, a detailed analysis of mitral regurgitation, and spatial-geometric ratio of the valve and the left ventricle determine the success of surgical intervention in this group of patients.

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