Prognostic factors for progression of mitral regurgitation in patients with coronary heart disease after aortocoronary bypass surgery alone and in combination with surgical left ventricular reconstruction

• Main Authors: Iu I Buziashvili, I V Koksheneva, E M Khutsurauli, É U Asymbekova, L S Shakhnazarian, S T Abukov
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2014-01-01
• Series: Терапевтический архив
• Subjects: ischemic mitral regurgitation; mitral insufficiency progression; aortocoronary bypass surgery; surgical left ventricular reconstructio
• Online Access: https://ter-arkhiv.ru/0040-3660/article/view/31424
• ISSN: 0040-3660; 2309-5342

AIM: To identify risk and prognostic factors for mitral regurgitation (MR) progression after aortocoronary bypass surgery (ACBS) alone and in combination with surgical left ventricular (LV) reconstruction/MATERIAL AND METHODS: Data on 101 patients with coronary heart disease who had undergone surgical treatment: ACBS alone in 57 (56%) patients and that in combination with surgical LV reconstruction in 44 (44%)/RESULTS: In the late periods after ACBS alone, there was reduced or no MR in 18% of the patients; no substantial changes in MR in 52%, the latter being moderate; progression to significant mitral insufficiency (MI) in 30%. In the same periods after ACBS in combination with surgical LV reconstruction, there was a reduction in MR to its minimum or complete absence in 14% of the patients; no substantial change in the degree of MR in 54%, and progression to significant MI in 32%. The prognostic factors of MI progression after ACBs alone and in combination with surgical LV reconstruction were a more than 32-mm fibrous ring of the mitral valve (MV) (χ2=11.62; р=0.0001); a LV sphericity index of more than 0.65 cm (χ2=3.38; р=0.06); a myocardial scar lesion extent of more than 30% of the LV segments (χ2=4.7; р=0.03); a myocardial reserve of less than 25% (χ2=3.1; р=0.07) (when taking low-dose dobutamine)/CONCLUSION: Myocardial revascularization should be combined with MV intervention in patients with moderate MR and risk factors for its progression, such as significant LV remodeling (LV sphericity index of more than 0.65 cm), extensive LV scar lesion (more than 30% of the segments), a low myocardial reserve (less than 25%) during dobutamine test, and a MV fibrous ring of more than 32 mm).