Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare?
Background: Approximately 13-59% of myocardial infarction patients develop ischemic mitral regurgitation, impacting left ventricular function and increasing mortality risk. Optimal management of moderate ischemic mitral regurgitation remains controversial, raising the question of whether adding mit...
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University of Baghdad/ Al-Kindy College of Medicine
2024-12-01
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| Series: | مجله كليه طب الكندي |
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| Online Access: | https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/view/1963 |
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| author | Ahmed Abdelwahhab Mohamad Rushdi Mohamed Ayyad Ahmed Elminshawy |
| author_facet | Ahmed Abdelwahhab Mohamad Rushdi Mohamed Ayyad Ahmed Elminshawy |
| author_sort | Ahmed Abdelwahhab |
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Background: Approximately 13-59% of myocardial infarction patients develop ischemic mitral regurgitation, impacting left ventricular function and increasing mortality risk. Optimal management of moderate ischemic mitral regurgitation remains controversial, raising the question of whether adding mitral valve surgery to coronary artery bypass graft (CABG) has an overall advantage over revascularization or not.
Objective: To investigate the early and mid-term comparison between the two techniques.
Subjects and Methods: This randomized clinical trial was conducted at Assuit University Heart Hospital, on 50 patients randomized into two groups: Group A: 25 patients underwent CABG and Group B: 25 patients had CABG and mitral valve repair. Inclusion criteria was multi-vessel coronary artery disease, moderate ischemic mitral regurge (MR). All patients were subjected to full history taking, routine physical, laboratory investigations and transthoracic echocardiography. Intraoperative data was collected. Early outcomes included MR degree, and left ventricular (LV) diameters and function, ICU stay duration, and in-hospital mortality. Mid-term outcomes included MR degree, LV diameter and function.
Results: Groups had similar age and gender distribution. Repair procedures showed longer ischemic and operative times than CABG alone (P≤0.0001 and P=0.0012). Early post-operative, repair reduced MR significantly (P≤0.0001). At six months follow-up, CABG group had more rate of improvement than repair group (P≤0.0001).
Conclusions: In moderate ischemic mitral regurgitation with multi-vessel ischemic heart disease, adding mitral valve repair to CABG may reduce mitral regurgitation severity early and at six months compared to CABG alone. However, CABG alone offers shorter ischemic times and operative durations.
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| format | Article |
| id | doaj-art-5ead2e61504b4d98b79a6a35a86fec58 |
| institution | Kabale University |
| issn | 1810-9543 2521-4365 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | University of Baghdad/ Al-Kindy College of Medicine |
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| series | مجله كليه طب الكندي |
| spelling | doaj-art-5ead2e61504b4d98b79a6a35a86fec582024-12-05T04:19:27ZengUniversity of Baghdad/ Al-Kindy College of Medicineمجله كليه طب الكندي1810-95432521-43652024-12-0120310.47723/a44swk061889Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare?Ahmed Abdelwahhab0Mohamad Rushdi1https://orcid.org/0009-0004-2750-1187Mohamed Ayyad2Ahmed Elminshawy3Cardiothoracic Surgery department, Faculty of Medicine, Assiut University, EgyptCardiothoracic Surgery department, Faculty of Medicine, Assiut University, EgyptCardiothoracic Surgery department, Faculty of Medicine, Assiut University, EgyptCardiothoracic Surgery department, Faculty of Medicine, Assiut University, Egypt Background: Approximately 13-59% of myocardial infarction patients develop ischemic mitral regurgitation, impacting left ventricular function and increasing mortality risk. Optimal management of moderate ischemic mitral regurgitation remains controversial, raising the question of whether adding mitral valve surgery to coronary artery bypass graft (CABG) has an overall advantage over revascularization or not. Objective: To investigate the early and mid-term comparison between the two techniques. Subjects and Methods: This randomized clinical trial was conducted at Assuit University Heart Hospital, on 50 patients randomized into two groups: Group A: 25 patients underwent CABG and Group B: 25 patients had CABG and mitral valve repair. Inclusion criteria was multi-vessel coronary artery disease, moderate ischemic mitral regurge (MR). All patients were subjected to full history taking, routine physical, laboratory investigations and transthoracic echocardiography. Intraoperative data was collected. Early outcomes included MR degree, and left ventricular (LV) diameters and function, ICU stay duration, and in-hospital mortality. Mid-term outcomes included MR degree, LV diameter and function. Results: Groups had similar age and gender distribution. Repair procedures showed longer ischemic and operative times than CABG alone (P≤0.0001 and P=0.0012). Early post-operative, repair reduced MR significantly (P≤0.0001). At six months follow-up, CABG group had more rate of improvement than repair group (P≤0.0001). Conclusions: In moderate ischemic mitral regurgitation with multi-vessel ischemic heart disease, adding mitral valve repair to CABG may reduce mitral regurgitation severity early and at six months compared to CABG alone. However, CABG alone offers shorter ischemic times and operative durations. https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/view/1963Ischemic Mitral InsufficiencyCoronary Artery Bypass GraftMitral Valve Repair |
| spellingShingle | Ahmed Abdelwahhab Mohamad Rushdi Mohamed Ayyad Ahmed Elminshawy Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? مجله كليه طب الكندي Ischemic Mitral Insufficiency Coronary Artery Bypass Graft Mitral Valve Repair |
| title | Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? |
| title_full | Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? |
| title_fullStr | Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? |
| title_full_unstemmed | Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? |
| title_short | Moderate Ischemic Mitral Insufficiency at the Time of Coronary Artery Bypass Graft; Repair or Spare? |
| title_sort | moderate ischemic mitral insufficiency at the time of coronary artery bypass graft repair or spare |
| topic | Ischemic Mitral Insufficiency Coronary Artery Bypass Graft Mitral Valve Repair |
| url | https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/view/1963 |
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