중등도의 허혈성 승모판막 폐쇄부전증 환자에서 승모판막 수술의 유용성
Efficacy of Mitral Valve Surgery in Moderate Ischemic Mitral Regurgitation
허혈성승모판막 폐쇄부전증 Mitral Regurgitation;
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Objective : Patients with mitral regurgitation(MR) in the setting of coronary artery disease have a dismal long-term prognosis whether treated medically or surgically. Moreover, the optimal management of moderate ischemic MR at the time of coronary artery bypass grafting(CABG) remains the subjects of controversy. Thus, the present retrospective study was undertaken to determine if mitral valve surgery for moderate ischemic MR at the time of CABG might be preferable to CABG alone in terms of clinical outcome. Materials and Methods : Between January 1997 and December 2003, 34 patients with moderate(Gr 3/4) ischemic MR underwent CABG alone (Group Ⅰ, n=23) or CABG plus mitral valve surgery (Group Ⅱ, n=11). Operative mortality, long-term survival and echocardiographic method were used to evaluate the efficacy of mitral valve surgery in patients with moderate ischemic MR. The mean follow-up duration of each group was 69.3±4.3months and 53.1±4.9months. Results : There was no hospital mortality in both groups. There was one case of late mortality in Group Ⅰ. The mean number of bypass graft was similar(3.8±1.2 vs 3.7±1.3 respectively). Cardiopulmonary bypass time was longer in group Ⅱ(p=0.014). In group Ⅱ, all of the patients received mitral annuloplasty using ring. On immediate postoperative echocardiogram, mitral regurgitation was more reduced in group Ⅱ(p=0.002). Echocardiogram performed at last follow-up state showed no difference between the two groups except the grade of MR. Actuarial survival of both groups at 5 years was similar (95.5% vs 100%,p=0.48). Conclusions : This study shows that in selected patients with moderate ischemic MR, CABG without mitral valve surgery might be sufficient. However, MR severity and left ventricle volume more decreased in mitral valve surgery group. Therefore more large study is necessary to determine these effects on the ventricular function and long-term survival.