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Functional Mitral Valve Regurgitation And Coronary Artery Bypass Grafting In Patients With Ischemic Cardiomyopathy - Should We Operate Both Simultaneously?
Jens Garbade, Rahel Kluttig, Laura Matz, Piroze Davierwala, Martin Misfeld, Michael A. Borger, Friedrich-Wilhelm Mohr.
Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany.

OBJECTIVE: The goal of this study was to analyze the outcomes of mitral valve (MV) surgery for functional mitral regurgitation (MR) in combination with coronary artery bypass grafting (CABG) in patients with severe ischemic cardiomyopathy.
METHODS: From 1999 to 2011, a total of 380 patients (288 male) with functional (MR) and systolic dysfunction (mean ejection fraction 24.8 ± 6.2%) underwent MV surgery combined with CABG. Mean logistic Euro Score was 19.1%. Cardiogenic shock was present in 12.1% of patients and these patients were operated on as an emergency. Perioperative data was gathered prospectively and long-term follow up data retrospectively. Follow-up was 99.5% complete and was performed at a mean time span of 3.6 years postoperatively (range 0.01 - 11.5 years).
MV repair could be successfully performed in 88% of patients with implantation of a Carpentier-Edwards Physio Ring and or IMR Etilogix Ring in 57.6% and 24.8% of patients, respectively. Of the 45 patients (12%) undergoing MV replacement, 32 received a biological and 13 a mechanical valve. The mean number of coronary bypass grafts was 2.8 ± 1. Operation-, bypass- and cross clamp times were 326.1 ± 77.5, 134.8 ± 47.0 and 80.7 ± 28.3 minutes, respectively. Postoperatively, 20% of the patients needed an IABP and 2.6% required ECMO. The 30-day mortality was 12.9%. Long term mortality at 1, 5 and 10 years was 25%, 41.1% and 51.3% respectively. Early echocardiographic follow-up revealed excellent MV function in most patients. MV-related reoperation rate was required in 7.4% during follow up. Redo MV replacement was performed in 10 patients (2.6%) and redo MV repair in 2 patients (0.5%) at a mean postoperative time of 591 and 55 days, respectively. Early coronary bypass revision was necessary in 4 patients (1.1%). A further 13 patients required reoperation for other reasons including aortic valve replacement (n=8), ventricular assist devices (n=5) or heart transplantation (n=2).
CONCLUSIONS: MV and CABG surgery in patients with severe ischemic cardiomyopathy remains a challenging scenario. Despite the high riskrofile of these patients, adequate perioperative and long-term results can be achieved.

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