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Eur J Cardiothorac Surg 2005;28:104-108
© 2005 Elsevier Science NL

Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery

^a Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
^b Division of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA

Received 27 December 2004; received in revised form 14 March 2005; accepted 17 March 2005.

^* Corresponding author. Division of Cardiology, University of Southern California, 1510 San Pablo Street, 322, Los Angeles, CA 90033, USA. Tel.: +1 323 442 6131; fax: +1 323 442 6133. (Email: rpai{at}usc.edu).

Objective: Fate of MR following CABG is variable. Predictors of MR regression following CABG alone are not known. Methods: From our surgical registry, CABG patients with both pre-operative and post-operative resting echocardiograms at our institution were screened. Of the 523 patients identified, 92 had 3+ (n=65) or 4+ (n=27) MR on the pre-operative echocardiogram on a 0–4 scale, who had isolated CABG. MR regression was correlated with clinical, operative, electrocardiographic and echocardiographic variables. Results: Patient characteristics: age 68±11 years, 62% male, and LVEF 37±15%. MR grade decreased from 3.3±0.5 to 2.3±1.2 post-CABG. Residual 3 or 4+ MR post-CABG was present in 43 (47%) patients. Regression of MR (n=49) was associated with reductions in LV end-diastolic (P=0.006) and end-systolic (P=0.0005) dimensions, improvement in LVEF (P=0.01), longer cross-clamp time (P=0.04), use of beta-blockers (P=0.04) and lower presence of CVA as a possible marker of lower atherosclerotic burden (P=0.03). There was a trend towards increased mortality (P=0.3) with residual 3–4+ MR over a mean follow-up of 3.9 years. Conclusions: In nearly half of patients with 3–4+ MR, MR does not regress with CABG alone. Residual MR may be associated with increased mortality. Regression of MR is related to LV size reduction and improvement in LV function. Presence of myocardial viability, adequate revascularization, lack of excessive atherosclerotic burden and therapy with beta-blockers and ace-inhibitors may be critical for MR regression following CABG alone.

Key Words: CABG • Mitral regurgitation

Abbreviations: CABG = coronary artery bypass graft surgery • CVA = cerebral vascular accident • EKG = Electrocardiogram • IMR = ischemic mitral regurgitation • LA = left atrium • LV = left ventricle • LVd = left ventricle end diastolic dimension • LVEF = left ventricle ejection fraction • LVs = left ventricle end systolic dimension • MR = mitral regurgitation • NSR = normal sinus rythum • NYHA = New York Heart Association Class

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