Surgical treatment of ischemic mitral regurgitation triggers reverse remodeling of left heart chambers

Objective: Mild-to-moderate ischemic mitral regurgitation still poses debates on the necessity of adding mitral repair to the surgical revascularization. CABG with or without concomitant valve surgery trigger left atrial and ventricular reverse remodeling and improve the prognosis.

Methods: 69 patients with ischemic heart disease and mild-to-moderate ischemic mitral regurgitation were subjected to isolated revascularization (Group A). In another 71 patients mitral repair was additionally performed (Group B). Mean follow-up was 28 (6 to 52) months. Left atrial and ventricular dimensions and volumes were evaluated preoperatively and at the follow-up.

Results: The average improvement in effective left ventricular ejection fraction (LVEF) for all survivors was 6.2 ± 14.1% in Group A and 21.2 ± 12.3% in Group B (p<0.05). Significant left ventricular reverse remodeling was observed in 45% of Group A and in 55% of Group B survivors. The average reduction in left ventricular end-systolic volume index was 10 ± 23 ml/m² vs 13 ± 26 ml/m² (p - NS). Left atrial reverse remodeling was significant in 21% of Group A and 57% of Group B. The average left atrial volume index slightly increased in Group A with 4 ± 26 ml/m², but reduction with 15 ± 23 ml/m² was observed in Group B (p<0.05).

Conclusions: Surgical revascularization alone and in combination with mitral repair trigger reverse left ventricular remodeling which is significant for about half of the patients. Left atrial reverse remodeling strongly depends on the restoration of the valvular function. Still in about 21% of patients with isolated revascularization significant left atrial reverse remodeling is also observed.