Coronary artery bypass grafting alone for advanced ischemic left ventricular dysfunction with significant mitral regurgitation: Early and midterm outcomes in a small series
In 31 consecutive patients with ischemic left ventricular dysfunction and mitral regurgitation ranging from 2/4 to 3/4 (mean, 2.87 ± 0.34), we performed coronary bypass grafting alone and assessed early and midterm outcomes. Our patients' mean preoperative New York Heart Association functional class was 3.64 ± 0.48, and their mean left ventricular ejection fraction was 0.25 ± 0.05. Preoperative thallium imaging revealed that all patients had at minimum a partially reversible defect in the anterior wall. All patients survived the operation. Hospital length of stay ranged from 5 to 21 days (mean, 8.35 ± 4.07 days), and mean length of follow-up was 21.35 ± 13.24 months. Postoperatively, patients' functional classification improved to a mean of 1.32 ± 0.6; left ventricular ejection fraction improved to a mean of 0.43 ± 0.09; and severity of mitral regurgitation decreased to a mean of 1.35 ± 0.96. Statistical analysis showed that all improvements were significant. Five late cardiac deaths occurred. Preoperative variables showed no correlation with late death. However, postoperative left ventricular ejection fraction and mitral regurgitation did correlate with late death, which suggests that the reversibility of damaged ischemic myocardium plays an important role after revascularization. This study supports the concept that ischemic mitral regurgitation might well improve after myocardial revascularization regardless of its severity; therefore, it should not be corrected at the primary operation, except in patients with organic valvular changes.