Comparative study of mitral valve repair in ischemic and rheumatic mitral regurge

Background: Rheumatic affection is still a significant aetiology of mitral valve disease (MVD) in Egypt. Some of these patients with rheumatic predominant mitral regurge indicated for mitral repair may need a concomitant coronary artery bypass grafting (CABG). We aimed to compare the short-term outcomes of mitral valve (MV) repair in rheumatic and ischemic mitral regurge in patients undergoing CABG. Methods: Between January 2014 and December 2015, we operated 71 patients of combined CABG and mitral valve repair surgery (with either ischemic or rheumatic mitral pathology).These patients were divided into two groups, group I: included 35 patients of rheumatic pathology, group II: included 36 patients of ischemic pathology. We compared the two groups regarding the operative, postoperative and 6 months follow up results. Results: There was no significant difference between the two study groups regarding preoperative data with exception of age and diabetes mellitus (DM). Ischemic cases had significantly higher mean age (54.1 ± 5.2 versus 49.77 ± 6.3, P value = 0.002) and significantly higher incidence of DM (44% versus 17.1, P value = 0.013). Rheumatic MV disease group had 6 cases of MV repair failure (17.1% versus 0.0% in group II). Regarding postoperative data ischemic valve group had a higher percentage of low cardiac output (COP) (86.1% versus 60%, statistically significant, P > 0.013). Ischemic group had higher mortality (13.9% versus 2.9% in group I). There was no significant difference between the two studied groups regarding 6 months follow up data. Conclusions: Patients with ischemic MVD were in a worse cardiac condition with higher hospital mortality than patients with combined rheumatic MVD and coronary artery bypass grafting. Patients with rheumatic MVD were usually having very complex pathology and in need modifications of standard repair techniques. Once discharged from hospital, both groups had comparable short and mid-term outcomes