Document Detail

Mitral valve surgery simultaneous to coronary revascularization in patients with end-stage ischemic cardiomyopathy.
MedLine Citation:
PMID:  16440144     Owner:  NLM     Status:  MEDLINE    
Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, predicts a poor outcome in terms of survival and morbidity. Between 1995 and 2003, 180 consecutive patients with impaired LV function and chronic ischemic MVR underwent cardiac surgery. Fifty-four patients (group I), MVR (grade III-IV) underwent simultaneous MV surgery and coronary artery bypass grafting (CABG); 40 patients (group II), MVR (grade II-III), and 86 patients (group III), MVR (grade I-II), underwent CABG alone. In group I, MV repair was performed in 36 patients (group IA) and MV replacement in 18 (group IB). The incidence of hospital death was similar between groups. The actuarial event-free survival was significantly lower in group than in groups II and III (P = 0.0045) and I (P = 0.038). The overall actuarial survival was significantly higher in group IA than in group IB (P = 0.027). Postoperatively, the LV ejection fraction (P < 0.001), LV end-diastolic diameter (P < 0.001), LV end-systolic diameter (P < 0.01), and cardiac index (P < 0.001) improved significantly in group I. The regurgitation fraction decreased significantly in Groups I and III after surgery (P < 0.001 and P = 0.003, respectively). Both MV repair and replacement that preserves subvalvular apparatus in patients with end-stage ischemic myocardiopathy offer an acceptable outcome. Mitral valve repair simultaneous to CABG improves significantly the LV function and its geometry. In patients with mild to moderate mitral regurgitation, CABG alone may be performed with good overall survival, but with lower event-free survival than those undergoing concomitant mitral valve repair.
Massimo Bonacchi; Edvin Prifti; Massimo Maiani; Giacomo Frati; Nadia S Nathan; Marzia Leacche
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart and vessels     Volume:  21     ISSN:  0910-8327     ISO Abbreviation:  Heart Vessels     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-27     Completed Date:  2007-08-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8511258     Medline TA:  Heart Vessels     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  20-7     Citation Subset:  IM    
Cattedra e Scuola di Specializzazione in Cardiochirurgia, Università degli Studi di Firenze, University Hospital of Florence Careggi, Florence, Italy.
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MeSH Terms
Analysis of Variance
Cardiomyopathies / etiology,  physiopathology,  surgery*,  ultrasonography
Chronic Disease
Coronary Artery Bypass*
Disease-Free Survival
Echocardiography, Doppler, Color
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Hospital Mortality
Middle Aged
Mitral Valve Insufficiency / etiology,  physiopathology,  surgery*,  ultrasonography
Myocardial Ischemia / complications,  physiopathology,  surgery*,  ultrasonography
Retrospective Studies
Severity of Illness Index
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Left / surgery
Ventricular Remodeling

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