Role of Dobutamine Stress Echocardiography in Prediction of Reversibility of Moderate Ischemic Mitral Regurgitation In Patients Undergoing CABG

Ibrahim  Kasab; Mahmoud Ahmed; Mohammed  Safan; Basem  Aglan; Mohammed  Elgazzar

Ibrahim Kasab Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mahmoud Ahmed Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Safan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Basem Aglan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Elgazzar Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Ischemic Mitral Regurgitation, Coronary Artery Bypass Grafting, Mitral Valve, Dobutamine Stress Echocardiography

Abstract

Background: Ischemic mitral regurgitation (IMR) is a frequent consequence of ischemic heart disease (IHD) and commonly occurs in patients undergoing coronary artery bypass grafting (CABG). The best approach for managing moderate IMR remains debated, especially concerning the necessity of mitral valve surgery (MVS) alongside CABG. This study evaluates the role of dobutamine stress echocardiography (DSE) in predicting the reversibility of moderate IMR and its effect on surgical outcomes.

Methods: This cross-sectional study included 60 patients with moderate IMR undergoing CABG, with or without MVS, based on DSE findings. Patients were divided into two equal groups: Group A (CABG alone) and Group B (CABG with MVS). Clinical, echocardiographic, and postoperative data were collected, and patients were followed for six months.

Results: No significant difference in short-term survival was observed between the groups. However, the CABG+MVS group showed greater improvement in IMR severity, with 96.6% achieving none-to-mild IMR at follow-up compared to 80% in the CABG-only group (p = 0.04). Additionally, the effective regurgitant orifice area (EROA) was significantly smaller in the CABG+MVS group (5.90 ± 3.63 mm² vs. 20.03 ± 8.41 mm², p < 0.001). Despite these benefits, the incidence of low cardiac output syndrome (LCOS) was higher in the CABG+MVS group (60% vs. 33.3%, p = 0.03).

Conclusion: Combined CABG and MVS significantly improves IMR severity and clinical outcomes in patients with moderate IMR but increase the risk of LCOS. Preoperative DSE is a valuable tool in selecting appropriate candidates for MVS.