Mitral Valve Structure in Addition to Myocardial Viability Determines the Outcome of Functional Mitral Regurgitation After Coronary Artery Bypass Grafting.

Abstract

BACKGROUND:

Coronary artery bypass grafting (CABG) reduces functional mitral regurgitation (MR) associated with ischemic heart disease, although the predictive factors or mechanisms of reversibility of functional MR after CABG are not fully understood.We investigated whether mitral valve structure is associated with the outcome of functional MR after CABG.Methods and Results:From a consecutive series of 98 patients with mild-moderate functional MR preoperatively who underwent isolated CABG, we enrolled 66 patients who were followed up for >1 year postoperatively using echocardiography. The degree of MR was reduced in 34 patients (52%) postoperatively, in association with a lower rate of in-hospital treatment for cardiac failure in the long term, compared with the 32 patients (48%) with residual MR postoperatively. The patients with reduced MR postoperatively had longer estimated coaptation length and more anteriorly or centrally directed MR jets than those without reduced MR. On statistical analysis, the addition of estimated coaptation length and jet direction to the reported predictors (ejection fraction, left ventricular end-diastolic dimension, and tenting height) more accurately predicted changes in post-CABG MR than the reported 3 factors alone.

CONCLUSIONS:

Residual MR was associated with the emergence of congestive heart failure in the long term after CABG. A specific mitral valve structure, such as large mitral leaflet size or predominant tethering of the posterior leaflet, was a predictive factor for the reversibility of post-CABG functional MR.

• Authors: Shohei Yoshida, Satsuki Fukushima, Shigeru Miyagawa, Teruya Nakamura, Yasushi Yoshikawa, Hiroki Hata, Shunsuke Saito, Daisuke Yoshioka, Keitaro Domae, Noriyuki Kashiyama, Kouji Yamamoto, Ayumi Shintani, Satoshi Nakatani, Koichi Toda, Yoshiki Sawa
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 81 Issue 11 Pg. 1620-1627 (Oct 25 2017) ISSN: 1347-4820 [Electronic] Japan
• PMID: 28626146 (Publication Type: Journal Article)

Topics

• Aged
• Coronary Artery Bypass
• Echocardiography
• Female
• Heart Failure (etiology)
• Humans
• Male
• Middle Aged
• Mitral Valve (pathology, surgery)
• Mitral Valve Insufficiency (surgery)
• Myocardium (pathology)
• Treatment Outcome