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When to repair ischemic mitral valve regurgitation? An algorithmic approach

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Summary

Background

Despite huge progress in the surgical management of ischemic mitral regurgitation, there is still controversy regarding the ideal treatment option.

Aims

Our study aimed to define an algorithmic approach in order to select those patients who will benefit the most from concomitant mitral valve procedure.

Methods

Patients with mitral regurgitation (MR) who met the inclusion criteria were included in our study. Patients with structural MR including ruptured chordae or papillary muscle, abnormal leaflet thickening, annular calcification, or other valvular or congenital heart diseases, ventricular aneurysms and those who were candidates for other surgical procedures were excluded. A total of 350 patients (about 12 %) were classified as having ischemic mitral regurgitation (IMR) and were enrolled in our analysis. All the patients underwent coronary artery bypass grafting and by the designed algorithmic approach were also decided to have additive procedures for their concomitant IMR.

Results

Six months survival was 91.5 % among all the patients in this study. During the follow-ups 86.9 % of the patients survived . Overall mortality rate was 13.1 % (n = 46), of which 7.1 % (n = 25) occurred due to cardiac and 6 % (n = 21) as a result of a non-cardiac cause.

Conclusion

Individualising methods to select patients suffering from IMR for concomitant mitral valve procedure and coronary artery bypass grafting (CABG) seems to serves more effectively by reducing unnecessary surgeries and at the same time not missing absolute indications for concomitant valve repairs. Our algorithm showed a promising efficacy to effectively select patients for CABG and concomitant mitral valve procedures.

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Conflict of interest

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Cardiology and Cardiac Surgery, Day General Hospital, No. 1434873111, Tavanir Street, Valie Asr Avenue, Tehran, Iran

    F. Roshanali MD, A. Vedadian MD & S. Shoar MD

  2. Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    A. Vedadian MD, S. Shoar MD & M. H. Mandegar MD

  3. Department of General Surgery, Shariati General Hospital, Tehran, Iran

    S. Shoar MD

  4. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    S. Sandoughdaran MD & M. Naderan

Authors
  1. F. Roshanali MD
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  2. A. Vedadian MD
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  3. S. Shoar MD
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  4. S. Sandoughdaran MD
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  6. M. H. Mandegar MD
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Correspondence to S. Shoar MD.

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Roshanali, F., Vedadian, A., Shoar, S. et al. When to repair ischemic mitral valve regurgitation? An algorithmic approach. Eur Surg 45, 98–105 (2013). https://doi.org/10.1007/s10353-013-0197-9

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  • DOI: https://doi.org/10.1007/s10353-013-0197-9

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