Annuloplasty in functional mitral regurgitation and concomitant coronary heart disease: Impact of the LV-function

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

Methods: Out of 197 pats. receiving an annuloplasty because of functional MR between 2002 and 2006, 102 pats. had 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 pats. (37% female) to group 2 (Gr.2) with moderately reduced (EF < 50% and ≥30%) n = 40 pats. (32% female) and group 3 (Gr.3) with severely reduced LV function (EF < 30%).), n = 35 pats. (31% female). The follow-up included echocardiography and clinical examination.

Results: Follow-up time was 34 ± 24 months. All groups were comparable in terms of mean age (66.5 ± 9.7 years) and NYHA-class (2.6 ± 0.7), p = n.s.. EuroSCORE was significantly higher in Gr.3 vs. Gr.1 (9.8 ± 10 vs. 6.5 ± 3, p < 0.05). A significantly higher proportion of pats. had a previous myocardial infarction in Gr.3 vs. Gr.1 (52% vs. 39%, p < 0.05). There was no difference between groups in mean OR- (348 ± 107 min), ECC- (185 ± 57 min), cross-clamp-time (116 ± 32 min), additional bypass-grafting (2.4 ± 1), ICU- (5.6 ± 4.8 days) and hospital-stay (10.8 ± 8.8 days). 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 pats. independently of LV-function. However, at follow-up the proportion of pats. with non/mild MR had significantly decreased only in Gr.3, and remained stable in all other pats. (78% in Gr.3 vs. 95% in Gr.1 and 2, p < 0.05). At follow-up LV function of pats. in Gr.3 had significantly improved in 72%, in Gr.2 only in 30% (p < 0.05). In contrast severely reduced LV function of pats. in Gr.1 and 2 occurred in 5% and 9% respectively, 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).

Conclusion: Mitral valve repair demonstrated good functional results in all patients with operative risk not depending on the left ventricular function. Patients with preoperative severely reduced LV function have an excellent benefit in most survivors.