DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.020

Pages: 1403-1408

The surgical management of moderate functional mitral regurgitation (fMR) during coronary artery bypass grafting (CABG) remains a highly debated dilemma, as concomitant mitral valve (MV) intervention may prevent heart failure progression but risks prolonged cardiopulmonary bypass (CPB) and subsequent myocardial injury. This report presents two contrasting cases to highlight the critical role of intraoperative decision-making regarding concomitant MV correction. In Case 1, a combined CABG and MV repair was performed due to a mixed MR etiology, which significantly prolonged CPB time and resulted in severe post-bypass hemodynamic instability with delayed myocardial recovery. Conversely, in Case 2, a planned MV intervention was safely aborted after real-time intraoperative transesophageal echocardiography (TEE) demonstrated an immediate reduction in fMR severity following revascularization. This CABG-only approach successfully minimized ischemic exposure, leading to a rapid, smooth recovery and a dramatic early improvement in ejection fraction. These contrasting outcomes demonstrate that the management of moderate fMR during CABG should be highly individualized rather than protocol-driven. Real-time intraoperative TEE assessment and active, flexible communication between the anesthesiologist and surgeon are essential to safely omit unnecessary valvular interventions, thereby minimizing operative trauma and optimizing short-term recovery.