Preoperative Risk Factors for the Prognosis of Mitral Regurgitation in Patients with Coronary Artery Stenosis and Mitral Regurgitation Who Underwent Coronary Artery Bypass Surgery Alone

Jin, Ung; Park, Chan Beom; Choi, Si Young; Kim, Chi Kyung

Abstract

BACKGROUND: In the operation for coronary artery stenosis, the procedures for mitral regurgitation are restricted to cases of more than moderate mitral regurgitation or for the lesions in leaflets. This is based on the belief that the less than mild regurgitation are a form of reversible change results from ischemia with coronary artery stenosis. We studied the changes and prognostic factors of mitral regurgitation in patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone. MATERIAL ANDMETHOD: We reviewed the medical records of 90 patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone by a single surgeon from Jan. 1995 to Dec. 2002. We grouped the patients according to the postoperative changes of mitral regurgitation, and then we statistically compared the findings of echocardiogram between preoperative and last follow up. RESULT: There were 24 cases with progression of mitral regurgitation, 12 cases without changes, 54 cases with improvements of mitral regurgitation in total 90 patients. The bypass to LAD was proven as the significant prognostic factor of mitral regurgitation. The preoperative end diastolic left ventricular volume index were higher in aggravated group with 105.38+/-38.89 mL compared to 71.75+/-28.45 mL in improvement group, and 84.00+/-11.66 mL in no change group. The grade of preoperative mitral regurgitation did not show significant differences among the groups.
CONCLUSION
The mitral regurgitation in patient with coronary artery stenosis can be improved after the coronary artery bypass surgery alone. However, the expectation of improvements based on the degree of preoperative mitral regurgitation can not be justified, therefore, the procedures for mitral regurgitation should be aggressively considered even in the cases of mild mitral regurgitation. Also, further study should be performed to identify the exact prognostic factors of mitral regurgitation including the left ventricular volume index, and whether the left anterior descending artery has been bypassed.