Concurrent Mitral Intervention for Patients with Moderate Ischemic Mitral Regurgitation Undergoing Coronary Artery Bypass Grafting: a Case Series

MP014 

Abstract Submission 

Luke Holland (1), Nikhil Sahdev (2), Guiqing Liu (3), Prakash Punjabi (4)

(1) Hammersmith Hospital, London, NA, (2) N/A, United Kingdom, (3) Hammersmith Hospital, ISLEWORTH, London UK, (4) Imperial College London / Hammersmith Hospital, London, London

Luke Holland    -  Contact Me
Hammersmith Hospital

Nikhil Sahdev    -  Contact Me
N/A

Guiqing Liu    -  Contact Me
Hammersmith Hospital

*Prakash Punjabi    -  Contact Me
Imperial College London / Hammersmith Hospital

Luke Holland    -  Contact Me
Hammersmith Hospital

Objective: It is well established that patients with coronary heart disease can develop ischemic chronic secondary mitral regurgitation (MR) due to the effect of left ventricular remodelling on mitral valve (MV) function. In patients who for coronary artery bypass grafting (CABG) and who also have a degree of MR, it is conceivable that revascularisation alone may improve myocardial blood supply, recruit hibernating myocardium and reduce the severity of MR, without the need for surgical intervention on the valve per se. The amount of MR that is acceptable to leave without surgical correction is a topic of debate. The 2020 ACC/AHA guidelines provide a level 2a recommendation that MV surgery is reasonable in patients with severe ischemic MR undergoing CABG. These guidelines do not make a recommendation for those patients with moderate MR. Our objective was to assess the incidence of early and late recurrence of regurgitation in patients with moderate MR undergoing concurrent CABG and MV surgery.

Methods: A database of all patients operated on by a senior mitral surgeon from 2015 – 2022 was retrospectively searched to identify patients who had simultaneous CABG and MV surgery. Patients were screened to identify those patients who had ischemic secondary MR that had been graded as 'moderate' in severity. Data on severity of MR, mean transmitral gradient and left ventricular ejection fraction (LVEF) were collected at baseline, 1 year follow-up and latest follow-up. Recurrence was defined as more than mild MR at follow-up.

Results: Twelve patients were included in our analysis with a mean age of 68 years (range 58 – 80). All underwent CABG and concurrent MV repair (n = 9) or MV replacement (n = 3). There was no statistically significant difference between LVEF (%) at baseline (43.6 +/- 8.5) and follow-up (46.9 +/- 10.2, p = 0.30). At 1 year, all 12 patients were alive and no patients (n = 0) had recurrence of MR. Late follow-up data was available for 8 patients. At a mean of 1287 days (3.5 years) post-op, 1 patient had developed mild-moderate recurrence and 1 patient had died (non-cardiac cause of death).

Conclusions: In this highly selected cohort of patients, our experience demonstrates that moderate ischemic secondary MR can be treated surgically at the same time as CABG with low risk of recurrence at early and late follow-up. The majority can be treated successfully with a downsize annuloplasty, but a small group will warrant replacement.

Ischemic Mitral Regurgitation