Mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation

Soares, Evelyn Figueira; Santos, Cecília Andrade; Figueiredo, Omar Jacobina; Lima, Renato Oliveira Albuquerque; Escobar, Rodrigo; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

doi:10.1016/j.repc.2012.12.002

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…However, they underwent other valves procedures on pulmonary or tricuspid valves less frequently than non-COPD patients. In this way, Sá et al [21] found that mitral valve replacement may be performed safely, concomitantly with CABG, in patients with moderate-to-severe ischemic mitral regurgitation. In such patients, the combined procedure resulted in lower rates of postoperative atrial fibrillation and low cardiac output than CABG only.…”

Section: Discussionmentioning

confidence: 99%

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

et al. 2019

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Purpose We examined trends, characteristics and in-hospital outcomes in mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without chronic obstructive pulmonary disease (COPD) in Spain from 2001 to 2015. We also identified factors associated with in-hospital mortality (IHM) in both groups of patients according to the implanted valve type. Methods We analyzed data from the Spanish National Hospital Discharge Database for patients aged 40 years or over. We selected admissions of patients whose medical procedures included SMVR. We grouped hospitalizations by COPD status. Results Over 43,024 patients identified, 83.63% underwent mechanical mitral valve replacement and 16.37% bioprosthetic valve (6.71% and 7.78% with COPD, respectively). The incidence of SMVR decreased for mechanical valves and increased for bioprosthetic valves over time in both groups of patients. The incidence of SMVR admissions was lower among COPD patients than in those without COPD, both for mechanical and bioprosthetic valves. IHM decreased significantly over time, regardless of the type of valve, in both groups of patients. COPD was associated with a significant increase in IHM, but only among patients who underwent bioprosthetic SMVR (OR 1.32, 95% CI 1.01–1.73). Conclusions The incidence of mechanical SMVR decreased while that of bioprosthetic SMVR increased over time in both groups of patients. COPD patients were less surgically operated than non-COPD patients for both valve types. In COPD patients, bioprosthetic SMVR was proportionally more used than mechanical SMVR. Mortality decreased over time for both valve types in patients with and without COPD. COPD increased in-hospital mortality among patients undergoing a biological SMVR.

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Section: Discussionmentioning

confidence: 99%

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

et al. 2019

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“…Previous studies have shown that severe ischaemic heart disease usually presents with some degree of mitral regurgitation (MR) that may need concomitant mitral valve replacement (MVR) along with coronary revascularization. 1 In the same context, current guidelines recommend evaluation of coronary artery disease (CAD) and subsequent revascularization of clinically significant CAD in all patients undergoing MVR for primary MV disease (MVD). 2 , 3 While both uncorrected CAD and residual MR after isolated coronary revascularization have shown negative impacts on the perioperative and long-term outcomes of patients with mitral valve disease (MVD); combined procedure [MVR + coronary artery bypass graft (CABG)] is also not devoid of complications.…”

Section: Introductionmentioning

confidence: 99%

Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis

Ullah

Gul

Saleem

et al. 2022

European Heart Journal Open

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Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy. Methods The National Inpatient Sample (NIS) database (2002-2018) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). Results A crude population of 6,145,694 (CABG-only 3,971,045, MVR-only 1,933,459, MVR+CABG 241,190), while a subset of matched cohort 724,237 (CABG-only 241,436, MVR-only 241,611 vs. MVR+CABG 241,190) was included in the PSM analysis. The combined MVR+CABG procedure had significantly higher adjusted odds of MACE (OR 1.13, 95% CI 1.11-1.14 and OR 1.96, 95% CI 1.93-1.99) and in-hospital mortality (OR 1.29, 95% CI 1.27-1.31 and OR 2.1, 95% CI 2.05-2.14) compared with CABG and MVR-alone, respectively. Similarly, the risk of post-procedure bleeding, major bleeding, acute kidney injury, cardiogenic shock, sepsis, need for intra-aortic balloon pump (IABP), mean length of stay (LOS) and total charges per hospitalization were significantly higher for patients undergoing the combined procedure. These findings remained consistent on yearly trend analysis favoring the isolated CABG and MVR groups. Conclusion Combined procedure (MVR+CABG) in patients with MVD and CAD appears to be associated with worse in-hospital outcomes, increased mortality and higher resource utilization compared with isolated CABG and MVR procedures. Randomized controlled trials are needed to determine the relative safety of these procedures in the full spectrum of baseline valvular and angiographic characteristics.

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“…Para realizar esta afirmación, nos basamos en el hecho de que la presencia de regurgitación mitral tiende a incrementar el cálculo de la fracción de eyección, la cual es muy dependiente de la postcarga. (1,13,70,88,100,104,116,117,119,123,124,125,129,130,142,190,219,224) Una fracción de eyección del ventrículo izquierdo más alta, en el contexto de una sobrecarga aguda de volumen del ventrículo izquierdo secundaria a la presencia de regurgitación mitral que ocurre de manera temprana en el pág. 133 transcurso de un infarto agudo de miocardio, puede enmascarar la verdadera extensión del daño miocárdico.…”

Section: Pág 131unclassified

“…El aparato valvular mitral (1,140,145,209,241) está constituido por la pared auricular izquierda, los músculos papilares y las regiones de la pared ventricular sobre la que asientan el anillo valvular, las cuerdas tendinosas -que comunican ambos músculos papilares con los velos valvulares-los velos mitrales anterior y posterior, y dos comisurasmedial y lateral-donde confluyen los velos valvulares. El funcionamiento normal de la válvula mitral depende de una adecuada interacción entre todos estos elementos.…”

unclassified

“…Derivada de la interrelación entre la magnitud de la cardiopatía isquémica y la presencia ó ausencia de insuficiencia mitral, podemos dividir la regurgitación mitral en 2 grandes grupos según su etiopatogenia: (61,62,75,87,(100)(101) pág. 2 1. La que tiene su origen en la existencia de una valvulopatía mitral con un sustrato orgánico de base, previa a la aparición del infarto agudo de miocardio, a la cual nos referiremos en este trabajo como regurgitación mitral de etiología degenerativa.…”

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Valor de la insuficiencia mitral previa a un primer infarto de miocardio, en el pronóstico clínico y la hemodinámica ventricular

Carbonero¹,

David²

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regurgitación mitral previa a un infarto agudo de miocardio en la función del ventrículo izquierdo y su geometría 7.4.Interrelación de la regurgitación mitral con el remodelado de aurícula izquierda y la inestabilidad eléctrica 7.5.Conexión existente entre la regurgitación mitral y la activación del sistema neurohormonal, el sistema neurovegetativo y las citoquinas 7.6.Insuficiencia mitral previa a un primer infarto agudo de miocardio y mortalidad cardiovascular 7.7.Papel pronóstico de la insuficiencia mitral previa a un primer infarto agudo de miocardio 7.8.Papel pronóstico de la fibrilación auricular 8.Limitaciones 9.Conclusiones 9.1.Conclusiones generales Anexo Definiciones

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Mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation

Abstract: CABG+MVR can be performed safely in patients with moderate-to-severe IMR. CABG+MVR resulted in lower rates of complications than CABG only. Both surgical approaches resulted in significant improvement of postoperative LVEF. However, there was greater improvement in the CABG+MVR group.

Cited by 7 publications

References 23 publications

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015)

Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis

Valor de la insuficiencia mitral previa a un primer infarto de miocardio, en el pronóstico clínico y la hemodinámica ventricular

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