Annuloplasty in functional mitral regurgitation and concomitant coronary heart disease: Functional and clinical outcome

Objective: The aim of the study was to analyse the impact of preoperative LV-function on clinical and functional outcome in patients (pts.) with functional mitral regurgitation (MR) and coronary heart disease.

Methods: Out of 197 pts. receiving an annuloplasty due to functional MR between 2002 and 2006, 102 pts. underwent concomitant bypass-grafting and were included in this retrospective analysis. We compared group 1 (Gr.1) with normal left ventricular (LV) function (ejection fraction EF 50%), n = 27 pts. to group 2 (Gr.2) with moderately reduced (EF  < 50% and ≥30%) n = 40 pts. and group 3 (Gr.3) with severely reduced LV function (EF  < 30%) n = 35 pts.. Follow-up included functional stress-echocardiography (TTE at 50 and 100 W ergometry) and clinical examination with quality of life appraised by EuroQol 5D form.

Results: Follow-up time was 41 ± 23 months. All groups were comparable in terms of mean age, sex and NYHA-class. Logistic EuroSCORE was significantly higher in Gr.3 vs. Gr.1 (9.8 ± 10 vs. 6.5 ± 3, p < 0.05). There were no differences between groups regarding perioperative data. Postoperatively use of high dose inotropics was significantly more frequent in Gr.3 vs. Gr.1 and 2 (23% vs. 11% and 8%, p < 0.05). Support with IABP was only required in Gr.2 and 3 (12% vs. 26% p < 0.05). 30 day mortality was 11.1% in Gr.1, 5% in Gr.2 and 9% in Gr.3 (p = n.s.).

Echocardiography at discharge revealed non/mild mitral regurgitation (MR) in 96% all pts. independently of LV-function. At follow-up moderate MR occurred more significantly in Gr. 3 vs. Gr. 1 and Gr. 2 (22% in Gr.3 vs. 5% in Gr.1 and 2, p < 0.05). In stress-TTE MR did not increase in any case. LV function in Gr.3 improved significantly compared to Gr. 2 (72% vs. 30%, p < 0.05) during follow-up. In contrast, impairment of LV function occurred in 5% in Gr.1 and 9% in Gr.2 (p = n.s.). Survival at follow-up was 78% in Gr.1, 60% in Gr.2 and 57% in Gr.3 (Gr.1 vs. 3 p < 0.05). Quality of live improved significantly only in group 3 (29 ± 23 vs. 78 ± 18 pre- vs. postoperatively, p < 0.05).

Conclusion: Mitral valve repair in this patient population demonstrated good functional results in almost all patients. Recovery of LV function in patients with preoperatively severely reduced LV function was demonstrated and coincided with benefit in quality of life.