Moderate Mitral Regurgitation with CABG in EF 40 or Less: To Repair or Not to Repair?

Abstract
Background: The presence of Ischemic Moderate Mitral Regurgitation in patients with ejection fraction 40 or less undergoing CABG surgery is still controversal. Should the mitral valve be repaired or is the CABG surgery sufficient to correct this regurgitation?
Aim of Study: This study was conducted to compare the echocardiographic and the clinical outcome of those patients after 2 years post-operatively.
Patients and Methods: This study was conducted from 2011 to 2014. Sixty patients with ischemic moderate MR were studied. They were randomly divided into 2 groups: Group A were 30 patients who underwent mitral valve repair together with CABG while Group B were 30 patients who underwent CABG only. Both groups were demographically similar to each other.
Results: Group A patients had a significantly improved functional capacity, reversed left ventricular remodeling and reduced degree of mitral regurgitation. The 2 year freedom from cardiac related events leading to death among patients of Group A and B was 92. 1%±1.5% versus 85.3%±2. 1% (p value <0.05). Ischemic mitral regurgitation affects significantly survival in patients with ejection fraction 40% or less. Ischemic mitral regurgitation promotes left ventricular remodeling in all patients. Among the 25 patients with moderate MR in Group B, 18 patients (60%) moved from moderate to severe MR at 2 years follow-up.
Conclusions: Ischemic mitral regurgitation significantly increases the incidence of cardiac related deaths among patients with ejection fraction 40% or less. 18 patients (60 who had moderate MR progressed to severe MR.