Araştırma Makalesi
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Is Isolated Coronary Artery Bypass Grafting Sufficient to Treat Moderate Chronic Ischemic Mitral Regurgitation?

Yıl 2021, Cilt: 1 Sayı: 1, 24 - 27, 16.12.2021
https://doi.org/10.29228/HMJ.5

Öz

Objective
Approach to ischemic mitral regurgitation is one of the most challenging areas of cardiovascular surgery. Since it is primarily due to left ventricular disturbances rather than mitral valve pathologies itself, interventional approach to IMR has always been controversial: To touch or no- touch. In this study, we aimed to research prognosis of IMR in patients underwent isolated coronary artery bypass surgery that had IMR preoperatively.
Materials and Methods
Thirty patients suffering from coronary artery disease and 2+/ 3+ IMR who underwent isolated- CABG were included to the study. Postoperative IMR degrees were compared to preoperative values in respect to left ventricular diameters/ volumes and ejection fraction.
Results
Postoperative 12th. mount transthoracic echocardiographic measures revealed Postoperative12 th. mount TTE findings; LVEF and IMR degrees were significantly decreased. On the other hand, LVEDD, LVESD, and left atrial diameter did not changed statistically.
Conclusion
We thought that isolated CABG has a decreasing effect on IMR degree and it’s safe and effective intervention in selected patients having CAD and concomitant 2+/ 3+ IMR preoperatively.

Kaynakça

  • Hickey MS, Smith LR, Muhlbaier LH, et al: Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation 1988; 78(3 Pt 2):I51-59.
  • Balu V, Hershowitz S, Zaki Masud AR, Bhayana JN, Dean DC: Mitral regurgitation in coronary artery disease. Chest 1982; 81(5):550-555.
  • Pinson CW, Cobanoglu A, Metzdorff MT, et al: Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation. J Thorac Cardiovasc Surg 1984; 88(5 Pt 1):663-672.
  • Connolly MW, Gelbfish JS, Jacobowitz IJ, et al: Surgical results for mitral regurgitation from coronary artery disease. J Thorac Cardiovasc Surg 1986; 91(3):379-388.
  • Karp RB, Mills N, Edmunds LH Jr: Coronary artery bypass grafting in the presence of valvular disease. Circulation 1989; 79(6 Pt 2):I182-184.
  • Cardic Surgery in the Adult 4th. Edition. Lawrence H. Cohn. 2012, by The McGraw-Hill Companies, Inc. Ch.29. Page 629- 646
  • Gorman JH 3rd, Gorman RC, Jackson BM, et al: Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model. Ann Thorac Surg 2003; 76(5):1556-1563.
  • Parish LM, Jackson BM, Enomoto Y, Gorman RC, Gorman JH III: The dynamic anterior mitral annulus. Ann Thorac Surg 2004; 78(4):1248-1255.
  • Bursi F, Enriquez-Sarano M, Nkomo VT, et al: Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation 2005; 111(3):295-301.
  • Calafiore AM, Mazzei V, Iaco AL, et al: Impact of ischemic mitral regurgitation on long-term outcome of patients with ejection fraction above 0.30 undergoing first isolated myocardial revascularization. Ann Thorac Surg 2008; 86(2):458-464; discussion 64-65.
  • Kumanohoso T, Otsuji Y, Yoshifuku S, et al: Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 2003; 125(1):135-143.
  • Aronson D, Goldsher N, Zukermann R, et al: Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med 2006; 166(21):2362-2368.
  • Downing SW, Savage EB, Streicher JS, et al: The stretched ventricle. Myocardial creep and contractile dysfunction after acute nonischemic ventricular distention. J Thorac Cardiovasc Surg 1992; 104(4):996-1005.
  • Adler DS, Goldman L, O’Neil A, et al: Long-term survival of more than 2,000 patients after coronary artery bypass grafting. Am J Cardiol 1986; 58(3):195-202.
  • Arcidi JM Jr, Hebeler RF, Craver JM, et al: Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone. J Thorac Cardiovasc Surg 1988; 95(6):951-959.
  • Dion R: Ischemic mitral regurgitation: when and how should it be corrected? J Heart Valve Dis 1993; 2(5):536-543.
  • Tamaki N, Kawamoto M, Tadamura E, et al: Prediction of reversible ischemia after revascularization. Perfusion and metabolic studies with positron emission tomography. Circulation 1995; 91(6):1697-1705.
  • Schelbert HR: Different roads to the assessment of myocardial viability. Lessons from PET for SPECT. Circulation 1995; 91(6):1894-1895.
  • Christenson JT, Simonet F, Bloch A, et al: Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis 1995; 4(5):484-488; discussion 8-9.
  • Tolis GA Jr, Korkolis DP, Kopf GS, Elefteriades JA: Revascularization alone (without mitral valve repair) suffices in patients with advanced ischemic cardiomyopathy and mild-to-moderate mitral regurgitation. Ann Thorac Surg 2002; 74(5):1476-1480; discussion 80-81.
  • Talwalkar NG, Earle NR, Earle EA, Lawrie GM: Mitral valve repair in patients with low left ventricular ejection fractions: early and late results. Chest 2004; 126(3):709-715.
  • Mihaljevic T, Lam BK, Rajeswaran J, et al: Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 2007; 49(22):2191-2201.
  • Aklog L, Filsoufi F, Flores KQ, et al: Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation 2001; 104(12 Suppl 1):I68-75.
  • Czer LS, Maurer G, Bolger AF, DeRobertis M, Chaux A, Matloff JM: Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography. Tex Heart Inst J 1996; 23(4):270-278.
  • Fukushima S, Kobayashi J, Bando K, et al: Late outcomes after isolated coronary artery bypass grafting for ischemic mitral regurgitation. Jpn J Thorac Cardiovasc Surg 2005; 53(7):354-360.
  • Lam BK, Gillinov AM, Blackstone EH, et al: Importance of moderate ischemic mitral regurgitation. Ann Thorac Surg 2005; 79(2):462-470; discussion 70.
  • Prifti E, Bonacchi M, Frati G, et al: Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization. J Heart Valve Dis 2001; 10(6):754-762.
  • Harris KM, Sundt TM III, Aeppli D, Sharma R, Barzilai B: Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg 2002; 74(5):1468-1475.
  • Wong DR, Agnihotri AK, Hung JW, et al: Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation. Ann Thorac Surg 2005; 80(2):570-577.
  • Buja P, Tarantini G, Del Bianco F, et al: Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization. Int J Cardiol 2006; 111(1):26-33. Epub 2005.
  • Kim YH, Czer LS, Soukiasian HJ, et al: Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg 2005; 79(6):1895-1901.
  • Diodato MD, Moon MR, Pasque MK, et al: Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis. Ann Thorac Surg 2004; 78(3):794-799; discussion 9.

Orta Derecede Kronik İskemik Mitral Yetersizliği Tedavisinde İzole Koroner Arter Bypass Grefti Yeterli mi?

Yıl 2021, Cilt: 1 Sayı: 1, 24 - 27, 16.12.2021
https://doi.org/10.29228/HMJ.5

Öz

Amaç
İskemik mitral yetmezliğine yaklaşım, kalp- damar cerrahisinin gri alanlarından biri olmaya devam etmektedir. İskemik mitral yetmezliği, mitral kapağının kendi patolojisinden kaynaklanmak yerine bir sol ventrikül hastalığı olması nedeniyle, nasıl bir yaklaşımda bulunulacağı hala tartışılmaktadır: Girişimde bulunmak mı, dokunmamak mı? Bu çalışmamızda, preoperatif dönemde IMY olan ve izole CABG uyguladığımız hastalarda post operatif dönem İMY setrini inceledik.
Gereç ve Yöntemler
Çalışmamıza 2+/ 3+ İMY olup izole CABG uyguladığımız 30 hasta dahil edildi. Preoperatif ve postoperatif İMY dereceleri, EF, LV çapları ve volümleri mukayese edildi.BulgularPostoperatif dönemde EF ve İMY derecelerinde anlamlı ölçüde azalma olduğu buna karşılık sol ventrikül çap ve volümlerinde anlamlı farklılık olmadığı görüldü.
Sonuç
2+/ 3+ İMY olan koroner arter hastalarına yapılacak izole CABG girişiminin seçilmiş hasta grubunda İMY üzerinde iyileştirici etkisi olduğuna inanıyoruz.

Kaynakça

  • Hickey MS, Smith LR, Muhlbaier LH, et al: Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation 1988; 78(3 Pt 2):I51-59.
  • Balu V, Hershowitz S, Zaki Masud AR, Bhayana JN, Dean DC: Mitral regurgitation in coronary artery disease. Chest 1982; 81(5):550-555.
  • Pinson CW, Cobanoglu A, Metzdorff MT, et al: Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation. J Thorac Cardiovasc Surg 1984; 88(5 Pt 1):663-672.
  • Connolly MW, Gelbfish JS, Jacobowitz IJ, et al: Surgical results for mitral regurgitation from coronary artery disease. J Thorac Cardiovasc Surg 1986; 91(3):379-388.
  • Karp RB, Mills N, Edmunds LH Jr: Coronary artery bypass grafting in the presence of valvular disease. Circulation 1989; 79(6 Pt 2):I182-184.
  • Cardic Surgery in the Adult 4th. Edition. Lawrence H. Cohn. 2012, by The McGraw-Hill Companies, Inc. Ch.29. Page 629- 646
  • Gorman JH 3rd, Gorman RC, Jackson BM, et al: Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model. Ann Thorac Surg 2003; 76(5):1556-1563.
  • Parish LM, Jackson BM, Enomoto Y, Gorman RC, Gorman JH III: The dynamic anterior mitral annulus. Ann Thorac Surg 2004; 78(4):1248-1255.
  • Bursi F, Enriquez-Sarano M, Nkomo VT, et al: Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation 2005; 111(3):295-301.
  • Calafiore AM, Mazzei V, Iaco AL, et al: Impact of ischemic mitral regurgitation on long-term outcome of patients with ejection fraction above 0.30 undergoing first isolated myocardial revascularization. Ann Thorac Surg 2008; 86(2):458-464; discussion 64-65.
  • Kumanohoso T, Otsuji Y, Yoshifuku S, et al: Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 2003; 125(1):135-143.
  • Aronson D, Goldsher N, Zukermann R, et al: Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med 2006; 166(21):2362-2368.
  • Downing SW, Savage EB, Streicher JS, et al: The stretched ventricle. Myocardial creep and contractile dysfunction after acute nonischemic ventricular distention. J Thorac Cardiovasc Surg 1992; 104(4):996-1005.
  • Adler DS, Goldman L, O’Neil A, et al: Long-term survival of more than 2,000 patients after coronary artery bypass grafting. Am J Cardiol 1986; 58(3):195-202.
  • Arcidi JM Jr, Hebeler RF, Craver JM, et al: Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone. J Thorac Cardiovasc Surg 1988; 95(6):951-959.
  • Dion R: Ischemic mitral regurgitation: when and how should it be corrected? J Heart Valve Dis 1993; 2(5):536-543.
  • Tamaki N, Kawamoto M, Tadamura E, et al: Prediction of reversible ischemia after revascularization. Perfusion and metabolic studies with positron emission tomography. Circulation 1995; 91(6):1697-1705.
  • Schelbert HR: Different roads to the assessment of myocardial viability. Lessons from PET for SPECT. Circulation 1995; 91(6):1894-1895.
  • Christenson JT, Simonet F, Bloch A, et al: Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis 1995; 4(5):484-488; discussion 8-9.
  • Tolis GA Jr, Korkolis DP, Kopf GS, Elefteriades JA: Revascularization alone (without mitral valve repair) suffices in patients with advanced ischemic cardiomyopathy and mild-to-moderate mitral regurgitation. Ann Thorac Surg 2002; 74(5):1476-1480; discussion 80-81.
  • Talwalkar NG, Earle NR, Earle EA, Lawrie GM: Mitral valve repair in patients with low left ventricular ejection fractions: early and late results. Chest 2004; 126(3):709-715.
  • Mihaljevic T, Lam BK, Rajeswaran J, et al: Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 2007; 49(22):2191-2201.
  • Aklog L, Filsoufi F, Flores KQ, et al: Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation 2001; 104(12 Suppl 1):I68-75.
  • Czer LS, Maurer G, Bolger AF, DeRobertis M, Chaux A, Matloff JM: Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography. Tex Heart Inst J 1996; 23(4):270-278.
  • Fukushima S, Kobayashi J, Bando K, et al: Late outcomes after isolated coronary artery bypass grafting for ischemic mitral regurgitation. Jpn J Thorac Cardiovasc Surg 2005; 53(7):354-360.
  • Lam BK, Gillinov AM, Blackstone EH, et al: Importance of moderate ischemic mitral regurgitation. Ann Thorac Surg 2005; 79(2):462-470; discussion 70.
  • Prifti E, Bonacchi M, Frati G, et al: Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization. J Heart Valve Dis 2001; 10(6):754-762.
  • Harris KM, Sundt TM III, Aeppli D, Sharma R, Barzilai B: Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg 2002; 74(5):1468-1475.
  • Wong DR, Agnihotri AK, Hung JW, et al: Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation. Ann Thorac Surg 2005; 80(2):570-577.
  • Buja P, Tarantini G, Del Bianco F, et al: Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization. Int J Cardiol 2006; 111(1):26-33. Epub 2005.
  • Kim YH, Czer LS, Soukiasian HJ, et al: Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg 2005; 79(6):1895-1901.
  • Diodato MD, Moon MR, Pasque MK, et al: Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis. Ann Thorac Surg 2004; 78(3):794-799; discussion 9.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi, Kalp ve Damar Cerrahisi
Bölüm Araştırma Makaleleri
Yazarlar

Hayrettin Tekümit Bu kişi benim 0000-0002-5157-3592

Duygu Durmaz Bu kişi benim 0000-0001-9617-8046

Kamil Berki 0000-0001-6039-3473

Yayımlanma Tarihi 16 Aralık 2021
Gönderilme Tarihi 1 Kasım 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Tekümit H, Durmaz D, Berki K. Is Isolated Coronary Artery Bypass Grafting Sufficient to Treat Moderate Chronic Ischemic Mitral Regurgitation?. HTD / HMJ. 2021;1(1):24-7.

e-ISSN: 2791-9935