Long-term survival of patients with ischemic heart disease after surgical correction of moderate ischemic mitral regurgitation

Abstract

Aim: to assess effect of correction of moderate ischemic mitral regurgitation (IMR) in patients with ischemic cardiomyopathy (IMC) in immediate and remote period. Materials and methods. We included in a single center prospective study 76 patients with IMC, left ventricular ejection fraction ≤35%, and moderate IMR. Patients with indications to postinfarction aneurism repair were not included. For randomization we used the method of envelopes. Thirty-eight patients were randomized in the group where coronary artery bypass grafting (CABG) was combined with of mitral valve repair (MVR), and 38 patients in the control group of isolated CABG. Mean age of patients was 57±8 (from 30 to 75 лет) years. For IMR correction we used rigid MEDENG ring. Results. Inhospital mortality was 5.4% (n=2) after isolated CABG and 10.81% (n=4) after CABG + MVR. Main cause of death was acute heart failure. One- and 2-year survival was 84 and 78%, respectively, after CABG+MVR, and 84 and 71% after isolated CABG. There was significant difference in three-year survival between groups (hazard ratio [HR] of death 0.457, p=0.04). Five-year survival was 45 and 74% after isolated CABG and CABG+MVR, respectively (р=0.037). Factors associated with inhospital mortality were pulmonary hypertension (HR 2.177, 95% confidence interval [CI] 2.299 to 9.831; p=0.043), NYHA class IV chronic heart failure (HR 3.027, 95% CI 1.605 to 5.707; р=0.001), negative result of stress test echocardiography (HR 0.087, 95%CI 0.041 to 0.186; р<0.001), atrial fibrillation (HR 4.754, 95%CI 2.299 to 9.831; р<0.001). Conclusion. Correction of moderate IMR in patients with IMC leads to improvement of parameters of survival in remote period. Five-year survival after isolated CABG was 45%, while after CABG+MVR - 74% (р=0.037).