Analysis of Influencing Factors of Surgical Options for Coronary Atherosclerotic Heart Disease Complicated with Moderate Ischemic Mitral Regurgitation

Abstract

Background: There are several controversies regarding the surgical approach for patients with coronary atherosclerotic heart disease (CAHD) complicated with moderate ischemic mitral regurgitation (IMR). Methods: A retrospective study was performed among 115 patients divided into two groups. Clinical and echocardiographic parameters, including perioperative indexes and follow ups, degree of stenosis in the coronary arteries, and cardiac function index, were analyzed. Patients who died in the hospital due to complications during the perioperative period were defined as the deterioration group (deterioration of coronary artery bypass grafting, CABG vs. deterioration of coronary artery bypass grafting combined with mitral valve surgery, CABG+MVS: N = 7, 58.3% vs. N = 5, 41.7%), whereas the remaining patients were defined as the rehabilitation group (rehabilitation of CABG vs. rehabilitation of CABG+MVS: N = 52, 50.5% vs. N = 51, 49.5%). Data were compared between the rehabilitation of the CABG and CABG+MVS groups to explore the predictors for surgical method selection. Results: Postoperative patients who died during hospitalization were excluded (N = 12). At 1-year follow up, there were 52 patients in the CABG rehabilitation group and 51 in the CABG+MVS rehabilitation group. During the follow-up period, 10 patients died (rehabilitation of CABG vs. rehabilitation of CABG+MVS: N = 7, 13.7% vs. N = 3, 5.8%). Nevertheless, the difference was not statistically significant. The logistic regression analysis identified four independent factors when choosing the surgical modality: prior-myocardial infarction (prior-MI), preoperative atrial fibrillation (pre-AF), and the stenotic degree of the left circumflex (LCX) and left main (LM) arteries. Conclusions: Prior-MI, pre-AF, and the degree of stenosis in LCX and LM could influence the choice of surgical method. This study provided new insights into the treatment of CAHD with moderate IMR.