Posts Tagged‘annuloplasty’

How to handle the ischemic mitral valve during CABG surgery

This post refers to two intriguing presentations of this year’s EACTS meeting, held in Vienna. Both presentations deal with the chronically ischemic mitral valve (graded at least moderate) as a concomitant finding in patients qualifying for coronary artery bypass grafting. The indication for revascularization is an important differentiator: chronic mitral regurgitation due to past myocardial infarction can also be an entity by itself (i.e. without the need for a revascularization procedure). This entity poses a delicate and difficult question on the best option of how to deal with it. Surgery does not always deliver the desired result, the newer interventional option of Mitraclip® is currently in evolving investigation. I will come back to this issue with a dedicated post. Stay tuned!

Our clinical situation:

  • Angiographically confirmed ischemic heart disease (IHD) needing surgical revascularization
  • Concomitant, at least moderate mitral valve regurgitation due to restricted leaflet motion (no prolapse – Carpentier class IIIB) and / or annular dilatation, called Ischemic Mitral Valve Regurgitation (IMVR)

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A (relative) defeat

Let’s start with the most important thing: the patient is alive and well, hence  the word “relative”  mentioned in the title. This is  “just” about a “technical” defeat. A brief description of the case: patient with severe coronary artery disease and a severe mitral valve regurgitation with indication to  surgery (aortocoronary bypass with 4-5 grafts on all three main coronary artery  branches and mitral valve repair).

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