Concomitant mitral valve surgery in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting

Kim, Byung Jin; Kim, Yun Seok; Kim, Ho Jin; Ju, Min Ho; Kim, Joon Bum; Jung, Sung‐Ho; Choo, Suk Jung; Chung, Cheol Hyun

doi:10.21037/jtd.2018.05.148

Cited by 13 publications

(14 citation statements)

References 27 publications

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“…The length of hospital stays did not differ significantly between groups. These results partially contradict Kim and colleagues’ study [ 20 ]. They reported higher neurological and cardiac complications, low cardiac output, and mortality in CABG and MVR patients.…”

Section: Discussioncontrasting

confidence: 94%

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Predictors of Outcomes After Coronary Artery Bypass Grafting: The Effect of Concomitant Mitral Repair

Marghalani¹,

AlٍRahimi²,

Baeshen³

et al. 2023

Cureus

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Background Ischemic mitral regurgitation (IMR) or functional MR intensity with or without repair increases the risk of coronary artery bypass grafting (CABG), and if the contaminant is undertaken, it doubles the risk of the surgery. This study aimed to characterize patients with concomitant CABG and mitral valve repair (MVR) and assess the surgical and long-term outcomes. Methods We conducted a cohort study from 2014 to 2020 on 364 patients who underwent CABG. A total of 364 patients were enrolled and divided into two groups. Group I (n= 349) included patients with isolated CABG, and Group II included patients who underwent CABG with concomitant mitral valve repair (MVR) (n= 15). Results Regarding preoperative presentation, most patients were male: 289 (79.40%), hypertensive 306 (84.07%), diabetic 281 (77.20%), dyslipidemic 246 (67.58%), presenting with NYHA classes III-IV: 200 (54.95%), and upon angiography, found to have the three-vessel disease: 265 (73%). Regarding their age mean± SD and Log EuroSCORE median (Q1-Q3), they had a mean age of 60.94± 10.60 years and a median score of 1.87 (1.13-3.19). The most prevalent postoperative complications were low cardiac output 75 (20.66%), acute kidney injury (AKI) 63 (17.45%), respiratory complications 55 (15.32%), and atrial fibrillation (AF) 55 (15.15%). Regarding long-term outcomes, most patients reported class I NYHA 271 (83.13%) and an echocardiographic decrease in MR severity. Patients with a CABG + MVR were significantly younger (53.93± 15.02 vs. 61.24± 10.29 years; P= 0.009), had a lower ejection fraction (33.6 [ 25 -50] vs. 50 [43-55] %; p= 0.032), and had a higher prevalence of LV dilation (32 [9.17%]). EuroSCORE was significantly higher in patients with mitral repair (3.59 [1.54-8.63] vs. 1.78 (1.13-3.11); P= 0.022). The mortality percentage was higher with MVR but did not attain statistical significance. Intraoperative CPB and ischemic durations were longer in the CABG + MVR group. Furthermore, neurological complications were higher in patients with mitral repair (4 (28.57%) vs. 30 (8.65%), P= 0.012). The study’s follow-up duration median was 24 (9-36) months. The composite endpoint occurred more frequently in older patients (HR: 1.05 [95% CI: 1.02-1.09]; 0.001), patients with low ejection fraction (HR: 0.96 [95% CI: 0.93-0.99]; P= 0.006) and in patients with preoperative myocardial infarction (MI) (HR: 2.3 [95%: 1.14- 4.68]; P= 0.021). Conclusion Most IMR patients benefited from CABG and CABG + MVR, as evident by NYHA class and echocardiographic follow-up. CABG + MVR had a higher Log EuroSCORE risk with increased intraoperative cardiopulmonary bypass (CPB) and ischemic durations, which may have played a role in increasing the incidence of postoperative neurological complications. On follow-up, no differences were reported between the two groups. However, age, ejection fraction, and a history of preoperative MI were identified as factors affecting the ...

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Section: Discussioncontrasting

confidence: 94%

“…EF was significantly lower in CABG with MVR patients; moreover, these patients had a higher prevalence of LV dilatation. Kim and associates [ 20 ] reported comparable characteristics between patients with CABG alone versus CABG and mitral repair. However, patients with mitral repair had a significantly lower EF.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Outcomes After Coronary Artery Bypass Grafting: The Effect of Concomitant Mitral Repair

Marghalani¹,

AlٍRahimi²,

Baeshen³

et al. 2023

Cureus

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“…In addition, several studies including a 2009 meta-analysis [15] have reported no survival benefit to adding MV repair to CABG (95% confidence interval [CI] 0.90–1.14, P = .73) for patients with IMR. Byung et al [6] reported that during a median follow-up of 78.0 months, the incidence of all-cause mortality was 232 (5.8% per year) in CABG-only group and 54 (7.5% per year) in CABG + MV surgery group ( P = .12), which suggests that a concomitant MV surgery seems to confer no significant clinical benefits. This study also points that CABG plus MVR group does have a significantly increased rate of neurological events (14 events) than CABG-only group (4 events; P = .02).…”

Section: Discussionmentioning

confidence: 99%

“…MR is strictly quantified according to European Society of Echocardiography diagnostic criteria. [6]…”

Section: Methodsmentioning

confidence: 99%

Experience of the management of coronary artery bypass graft only on moderate ischemic mitral regurgitation

Wang

Li²,

Wang³

et al. 2019

Medicine

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To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.We retrospectively analyzed 109 patients with coronary artery disease (CAD) complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ± 17.98 months (range 36–96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.

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“…FIGURE 3: Forest plot comparing risk of mortality between two groups CABG: Coronary artery bypass surgerySources: References[7,8,12,[15][16][17][18]20,21] …”

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confidence: 99%

Comparison of Coronary Artery Bypass Grafting Combined With Mitral Valve Repair Versus Coronary Artery Bypass Grafting Alone in Patients With Moderate Ischemic Mitral Regurgitation: A Meta-Analysis

Sameer¹,

Malik²,

Choudry³

et al. 2023

Cureus

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The aim of this meta-analysis was to compare clinical outcomes between those who underwent coronary artery bypass grafting (CABG) alone and CABG with mitral valve repair (MVR) in patients with moderate ischemic mitral regurgitation. The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors performed a comprehensive search of international databases, including PubMed, EMBASE, and the Cochrane Library, for relevant studies published from inception to March 1, 2023. The search was performed again before the submission of the manuscript on March 20, 2023. Primary outcomes assessed in the present meta-analysis included early mortality and long-term mortality. Secondary outcomes assessed in the present meta-analysis included change in New York Heart Association (NYHA) score from baseline, change in ejection fraction (EF) from baseline (%), and major cardiovascular events (MACE). A total of 13 studies were included in the present meta-analysis. Out of 13 included studies, four were randomized control trials (RCTs) and nine were retrospective cohort studies.The pooled analysis showed that early mortality was significantly lower in patients in the CABG group compared to the CABG+MVR group (risk ratio [RR]: 0.47, 95% confidence interval [CI]: 0.31, 0.70). Long-term mortality was also lower in patients who underwent CABG compared to patients in the CABG+MVR group. However, the difference was statistically insignificant (RR: 0.88, 95% CI: 0.77, 1.02). No significant differences were reported in the EF score between patients who underwent CABG and patients who underwent CABG plus MVR (mean difference [MD]: 0.40, 95% CI: -1.90, 2.69). NYHA score was significantly lower in patients in the CABG+repair group compared to the CABG alone group (MD: 0.39, 95% CI: 0.06, 0.72).In conclusion, our meta-analysis suggests that concomitant MVR during CABG may not improve clinical outcomes in patients with moderate ischemic mitral regurgitation. Further clinical trials are needed to investigate this intervention in more detail.

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Concomitant mitral valve surgery in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting

Abstract: The addition of a concomitant MV surgery increased the risk of early mortality and complications in patients with moderate iMR undergoing CABG. In long-term clinical and echocardiographic outcomes, a concomitant MV surgery seemed to confer no significant clinical benefits.

Cited by 13 publications

References 27 publications

Predictors of Outcomes After Coronary Artery Bypass Grafting: The Effect of Concomitant Mitral Repair

Predictors of Outcomes After Coronary Artery Bypass Grafting: The Effect of Concomitant Mitral Repair

Experience of the management of coronary artery bypass graft only on moderate ischemic mitral regurgitation

Comparison of Coronary Artery Bypass Grafting Combined With Mitral Valve Repair Versus Coronary Artery Bypass Grafting Alone in Patients With Moderate Ischemic Mitral Regurgitation: A Meta-Analysis

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