The Kay Mitral Valve Repair in Coronary Artery Disease Concomitant With Ischemic Mitral Regurgitation

Abstract

Background: Ischemic mitral regurgitation is a major source of morbidity and mortality of myocardial infarction. Surgical intervention for significant ischemic mitral regurgitation at the time of coronary artery bypass grafting (CABG) is controversial and has always presented a great challenge. The purpose of this study was to describe the current surgical options for ischemic mitral incompetency and to discuss when mitral valve repair via the Kay method may be favored over mitral valve replacement. Methods: Twelve patients candidated for the Kay mitral valve repair plus CABG were recruited. The efficacy of mitral valve repair was echocardiographically recorded at follow-up. To validate the diagnosis of ischemic mitral regurgitation, we conducted a detailed chart review— which included all preoperative cardiac imaging tests at the first, sixth, and 12th postoperative months, as well as the operative records and pathology reports. Results: Twelve patients (5 male and 7 female) underwent CABG plus the Kay mitral valve repair. All the patients had significant mitral valve incompetency, which was resolved in all of them (P<0.05). There was no preoperative or postoperative mortality. No further postoperative mortality was reported at 1 year's follow-up. The Kay technique for mitral valve repair had a desirable result insofar as 8 (72.7%) patients had only mild mitral regurgitation and 4 (33.3%) had mild-to-moderate mitral regurgitation. Conclusions: In the current era and in Iran, mitral valve repair—especially via the Kay method—has been proven to confer improved short and long-term survival, decreased valve-related morbidity, and enhanced left ventricular function. Future randomized prospective clinical trials are needed to compare this cost-effective surgical technique with its counterparts. (Iranian heart Journal 2018; 19(3): 6- 14)