A Comparative Analysis Of Early Outcomes Of Simultaneous Mitral Valvuloplasty Or Mitral Valve Replacement In Patients Undergoing Coronary Artery Bypass Grafting

Objective: To compare and analyze the early effects of coronary artery bypass grafting plus mitral valvuloplasty or coronary artery bypass grafting plus mitral valve replacement in the treatment of coronary heart disease with moderate to severe ischemic mitral insufficiency,and to provide the basis for the selection of surgical methods for such patients.Materials and Methods: A retrospective analysis of 53 patients with coronary heart disease complicated with moderate to severe ischemic mitral regurgitation diagnosed in our hospital from January 2014 to January 2019.Among them,there were 32 males and 21 females,with an average age of 65.08±6.03 years old and an average weight of 60.29±9.37 kg.There were 30 cases in group A(coronary artery bypass grafting + mitral valvuloplasty)and 23 cases in group B(coronary artery bypass grafting + mitral valve replacement).Relevant indicators of patients before,during,one week after and three months after operation were collected.Data were grouped according to different surgical methods.SPSS 23.0 software was used to analyze the data.Results:Two patients who underwent coronary artery bypass grafting and mitral valvuloplasty died of ventricular fibrillation and low cardiac output syndrome respectively;two patients who underwent coronary artery bypass grafting and mitral valve replacement died of low cardiac output syndrome and renal failure respectively.There were no significant differences in the number of bypass grafts,aortic block time,cardiopulmonary bypass time,ventilator-assisted breathing time,intensive care time,hospital stay and complications between the two groups.Echocardiogram showed that the left ventricular ejection fraction had no significant difference between the two groups one week after operation and three months after operation,while the left atrial diameter and left ventricular end-diastolic diameter had significant decrease compared with those before operation.There was no significant difference in the degree of decrease of left atrial diameter and left ventricular end-diastolic diameter between the two groups at one week and three months after operation.Mitral regurgitation was eliminated in patients undergoing coronary artery bypass grafting and mitral valve replacement,and echocardiographic re-examination of patients undergoing coronary artery bypass grafting and mitral valvuloplasty at one week and three months after operation indicated that mitral regurgitation was also significantly improved.The cardiac function of the patients in both groups was significantly improved three months after operation.The patients who underwent coronary artery bypass grafting plus mitral valvuloplasty improved significantly compared with those who underwent coronary artery bypass grafting plus mitral valve replacement.Conclusion: For patients with coronary heart disease complicated with moderate to severe mitral regurgitation,early outcome of mitral valvuloplasty or mitral valve replacement is satisfactory.Compared with the two methods,mitral valvuloplasty can improve heart function more obviously in the early stage after operation,so it can be a preferred method.The long-term and medium-term effects of the two drugs need to be further studied.