Outcome of patients with ischemic cardiomyopathy undergoing mitral valve surgery combined with coronary artery bypass graft and additional procedures, a retrospective single-centre analysis of 475 consecutive patients

Objectives: The goal of this study was to analyze the outcome of complex mitral valve (MV) pathology and concomitant coronary arterial bypass graft (CABG) combined with additional procedures in patients with severe ischemic cardiomyopathy.

Methods: Within the last decade 475 patients (362 male) with severe MV pathology and systolic dysfunction (mean ejection fraction 25.0 ± 6.0%) underwent MV surgery combined with CABG. Of all patients 55 had additional tricuspid valve (TV) surgery, 37 had a MAZE procedure done, in 12 patients an ASD was closed and 2 patients had a postinfact septal rupture. Clinical data and information on complications, re-intervention and acute and long-term mortality were retrospectively gathered. Follow-up was made with a median time span of 1912 days (range 7 – 4198 days). The mean logistic Euro Score of these patients was 19.1%.

Results: MV could be successfully repaired in 88% of all patients, whereas rigid annuloplasty was used in 98% of these (mostly Carpentier-Edwards Physio Ring and Baxter Carpentier-Edwards Annuloplasty Ring). Of the 59 patients with MV replacement, 43 received a biological valve and 16 a mechanical one. The mean number of bypass-grafts was n = 2.5 ± 0.9. Operation-, bypass- and cross clamp time was 241.6 ± 53.3, 138.3 ± 16.0 and 82.3 ± 33.4 minutes respectively. The 30 day mortality of all patients was 12.2% with a follow up of 99.2% not depending on additional procedures. The long term mortality at 1, 5 and 10 years was 24.4%, 39.8% and 48.6% respectively.

MV-related reoperation rate was 8%. In 12 patients MV replacement was done at a mean postoperative time of 506 ± 661 days and 5 MV re-repairs were done at a mean postoperative time of 95.4 ± 56.7 days. Four patients (0.8%) needed a revision CABG within a median of 1 day postoperatively (mean 4.3 ± 6.3 days).

Conclusion: Considering the critical illness of these patients, good long-term results were observed after treatment of ischemic mitral regurgitation performing a mitral surgery in addition to a CABG. There is no significant difference in mortality of patients with additional TV repair, MAZE or ASD closure.