[Coronary artery bypass grafting surgery in left ventricular dysfunction patients complicated with mitral regurgitation].

Objective: To evaluate the efficacy of coronary artery bypass grafting (CABG) surgery in left ventricular dysfunction patients complicated with different degrees of ischemic mitral regurgitation (IMR). Methods: The clinical data of 525 patients (428 males and 97 females) undergoing CABG in Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, and Tianjin Medical University General Hospital between January 2015 and December 2018 were collected. The average age was (61±7) years old. Among them, the patients with moderate to serve IMR and left ventricular ejection fraction(LVEF)≤40% were further selected, and the outcomes of CABG were analyzed. Results: In total, 67 patients (48 males and 19 females) with moderate to severe IMR and LVEF≤40% were enrolled, among which 52 patients had moderate IMR, with a LVEF of 38%(35%, 40%). Transesophageal echocardiography (TEE) of 52 cases displayed no damage of papillary muscles, and ventricular wall motion was improved after CABG. Therefore, no treatment on the mitral valve was performed in this group. Six patients were with moderate-severe mitral insufficiency, with a LVEF of 38%(35%, 39%). After surgery, TEE found that the ventricular wall motion and regurgitation were improved, and the mitral valve structures were well. Thus, mitral valves were not treated in these patients. Nine patients were with severe mitral regurgitation, with a LVEF of 38%(35%, 39%). Two of them received valve repair because the papillary muscle function and the ring were well. Another 7 patients received valve replacements because the valve ring was dilatated and the leaflet was prolapsed. All patients recovered well. The LVEF increased significantly at 6 months after surgery [47%(45%, 48%) vs 38%(35%, 39%), P=0.024], and the left ventricular end diastolic diameter also became smaller [57(56, 59) mm vs 61(59, 64) mm, P=0.002]. Conclusions: For patients suffered from left ventricular dysfunction complicated with IMR, TEE is crucial to evaluate the valve function. To those with moderate-severe regurgitation, if papillary muscle function and the ring were seriously affected by ischemia, the valve replacement could facilitate the improvement of postoperative cardiac function.目的： 总结不同程度二尖瓣反流合并左室功能低下患者行冠状动脉旁路移植的治疗效果。 方法： 回顾性分析2015年1月1日至2018年12月31日期间，于中国医学科学院阜外医院深圳医院和天津医科大学总医院525例行冠状动脉旁路移植患者临床资料，其中男428例，女97例，年龄（61±7）岁。选取左室射血分数（LVEF）≤40%合并二尖瓣中度反流以上病例，分析不同程度二尖瓣反流患者预后及心功能恢复的效果。 结果： 入选患者中67例合并中度以上二尖瓣反流。52例术前反流中度，LVEF为38%（35%，40%），食管超声评估瓣膜结构良好，术中搭桥后评估室壁运动得到改善，未干预二尖瓣。6例术前反流中-重度，LVEF为38%（35%，39%），搭桥后食管超声评估室壁运动得到改善并且二尖瓣瓣叶及瓣下结构良好，反流减轻，未干预瓣膜。9例术前反流重度，LVEF为38%（35%，39%），2例术中探查二尖瓣乳头肌及腱索功能及位置尚好，同期行二尖瓣成形术，7例患者存在乳头肌及腱索移位明显，瓣环扩张，行二尖瓣置换；所有患者术后恢复良好，半年随访二尖瓣反流均减轻至中度及以下，LVEF较术前升高[47%（45%，48%）比38%（35%，39%），P=0.024]，左室舒张末期内径缩小[57（56，59）mm比61（59，64）mm，P=0.002]。 结论： 左室功能低下合并二尖瓣反流患者行冠状动脉旁路移植术前术中食管超声评估十分重要。对于中-重度以上反流，瓣下结构受缺血影响的患者，积极行二尖瓣置换手术，以利于术后心功能改善。.