Off-pump Surgical Therapy for Mild-to Moderate-Ischemic Mitral Regurgitation Using a Self-designed Device_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Yang , GU Chengxiong , LI Jingxing

Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

Keywords：

Ischemic mitral regurgitation; Off-pump coronary artery bypass grafting; Mitral valvuloplasty

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Abstract： Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation（IMR） using a self-designed device during off-pump coronary artery bypass grafting（OPCAB）. Methods From September 2009 to August 2011, six patients（4 males, 2 females； age was 52-73 years） with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis
diameter and left ventricular spherical index（left ventricular short-axis diameter/left ventricular long -axis diameter）were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus（3.43±0.08 cm vs.3.68±0.08 cm；t=5.430, P=0.001）, left ventricular short-axis diameter（4.80±0.21 cm vs.5.53±0.11 cm；t=7.530, P=0.001）and left ventricular spherical index（0.64±0.02 vs.0.74±0.01；t=11.110, P=0.002）significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class（New York Heart Association）. Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.

Citation： YU Yang,GU Chengxiong,LI Jingxing,et al.. Off-pump Surgical Therapy for Mild-to Moderate-Ischemic Mitral Regurgitation Using a Self-designed Device. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 244-247. doi: Copy

1.	Magne J, Sénéchal M, Dumesnil JG, et a1. Ischemic mitral regurgitation： a complex multifaceted disease. Cardiology, 2009, 112（4）：244-259.
2.	Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．.
3.	Fattouch K, Sampognaro R, Speziale G, et a1. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting.Ann Thorac Surg, 2010, 90（4）：1187-1194.
4.	Aklog L, Filsoufi F, Flores KQ, et a1. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104（12 Suppl 1）：I68-I75.
5.	Bouma W, van der Horst IC, Wijdh-den Hamer IJ, et a1. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg, 2010, 37（1）：170-185.
6.	于洋, 顾承雄, 韦华, 等. OPCAB同时行左心室室壁瘤缝缩术206例.中华胸心血管外科杂志, 2007, 23（3）：154-155.
7.	Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med, 1963, 112：112-117.
8.	Mittal AK, Langston M Jr, Cohn KE, et a1. Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study. Circulation, 1971, 44（2）：174-180.
9.	Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221.
10.	纪广玉, 徐志云, 邹良建，等. 冠心病合并慢性中度缺血性二尖瓣关闭不全的外科治疗.中国胸心血管外科临床杂志, 2007, 14（4）：248-251.
11.	吴若彬, 郑少忆, 郭惠明, 等. 冠心病合并缺血性二尖瓣关闭不全的处理方法. 中华胸心血管外科杂志，2004, 20（5）：271-273.
12.	Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20.
13.	Grossi EA，Crooke GA，DiGiorgi PL，et a1．Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 2006, 114（Suppl 1）：1573-1576．.
14.	Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419.
15.	Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763.
16.	Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512.
17.	Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717.
18.	Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．.

1. 　Magne J, Sénéchal M, Dumesnil JG, et a1. Ischemic mitral regurgitation： a complex multifaceted disease. Cardiology, 2009, 112（4）：244-259.
2. 　Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．.
3. 　Fattouch K, Sampognaro R, Speziale G, et a1. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting.Ann Thorac Surg, 2010, 90（4）：1187-1194.
4. 　Aklog L, Filsoufi F, Flores KQ, et a1. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104（12 Suppl 1）：I68-I75.
5. 　Bouma W, van der Horst IC, Wijdh-den Hamer IJ, et a1. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg, 2010, 37（1）：170-185.
6. 　于洋, 顾承雄, 韦华, 等. OPCAB同时行左心室室壁瘤缝缩术206例.中华胸心血管外科杂志, 2007, 23（3）：154-155.
7. 　Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med, 1963, 112：112-117.
8. 　Mittal AK, Langston M Jr, Cohn KE, et a1. Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study. Circulation, 1971, 44（2）：174-180.
9. 　Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221.
10. 　纪广玉, 徐志云, 邹良建，等. 冠心病合并慢性中度缺血性二尖瓣关闭不全的外科治疗.中国胸心血管外科临床杂志, 2007, 14（4）：248-251.
11. 　吴若彬, 郑少忆, 郭惠明, 等. 冠心病合并缺血性二尖瓣关闭不全的处理方法. 中华胸心血管外科杂志，2004, 20（5）：271-273.
12. 　Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20.
13. 　Grossi EA，Crooke GA，DiGiorgi PL，et a1．Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 2006, 114（Suppl 1）：1573-1576．.
14. 　Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419.
15. 　Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763.
16. 　Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512.
17. 　Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717.
18. 　Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Off-pump Surgical Therapy for Mild-to Moderate-Ischemic Mitral Regurgitation Using a Self-designed Device

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