OPCABG for Moderate CIMR in Elderly Patients: a Superior Option?

Abstract

ObjectiveTo compare the early and late outcomes of off-pump coronary artery bypass grafting and coronary artery bypass graft + mitral valve repair in elderly patients with moderate chronic ischemic mitral regurgitation.MethodsOne hundred and fifty elderly (age > 70 years) patients with moderate chronic ischemic mitral regurgitation who underwent off-pump coronary artery bypass grafting (n=95) or coronary artery bypass graft + mitral valve repair (n=55) between January 2007 and December 2014 were studied. They were subdivided according to presence or absence of high operative risk. Peri-operative variables and early operative outcomes were retrospectively studied. Survival, mitral regurgitation grade, and functional outcomes were prospectively analysed.ResultsBoth groups were comparable in terms of age (P=0.23), sex (P=0.74), left ventricle ejection fraction (P=0.6) and preoperative functional class (P=0.52). The mean number of grafts for off-pump coronary artery bypass grafting group was 3.14 and coronary artery bypass graft + mitral valve repair was 3.21. Off-pump coronary artery bypass grafting group had statistically significant better early operative outcomes i.e perioperative blood transfusions, intraaortic balloon pump usage, arrhythmias, renal dysfunction, liver dysfunction, sepsis, mean hours of ventilation, intensive care unit stay and operative mortality. On a prospective follow up of 5±2.33 years (1-9 years), coronary artery bypass graft + mitral valve repair in low operative risk subgroup had better improvements in mitral regurgitation grade than off-pump coronary artery bypass grafting. Both groups had similar improvements in functional class and cumulative survival was also comparable (63.2% vs. 54.5%).ConclusionOff-pump coronary artery bypass grafting is a safer alternative to coronary artery bypass graft + mitral valve repair with better early operative outcomes and comparable late survival and functional outcomes in elderly patients with moderate chronic ischemic mitral regurgitation, especially those with higher operative risk.

Change in Functional Moderate Mitral Regurgitation after Aortic Valve Replacement

“…Concentric remodeling would increase wall thickness and decrease the size of LV chambers. In addition, the excellent results of our study were also more relevant with the small LV size after operation than with those with large LV size [16] .…”

“…In our study, organic MR and patients with coronary artery diseases were also excluded because ischemic heart diseases could also cause functional MR [16] . Many reports showed that there were some predictors associated with the decrease of postoperative MR, such as LA size > 45 mm, pulmonary artery systolic pressure > 40 mmHg, and LVEDV > 54 mm [14] .…”

Risk Factors for Moderate or More Residual Regurgitation in Patients with Moderate Chronic Ischemic Mitral Regurgitation Undergoing Surgical Revascularization Alone

“…4) Surgical correction of moderate IMR at the time of coronary revascularization is still an unresolved controversy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Although it cannot be sufficient to eliminate IMR, CABG alone improves preoperative moderate IMR in selected patients. 3) It is crucial to determine which patients with moderate IMR are more likely to benefit from CABG alone and which patients with moderate IMR were not good candidates for CABG alone.…”

“…The overwhelming majority of previous studies have investigated the effects of CABG alone or the concomitant mitral valve procedure for the treatment of moderate chronic IMR. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, few reports have focused on determining which patients with moderate chronic IMR are more likely to benefit from CABG alone and which patients with moderate IMR may be good candidates for combined CABG and mitral valve procedures. Penicka and colleagues have reported that patients with moderate IMR were more likely to develop moderate or more residual MR after CABG alone in the case of the absence of viable myocardium and the presence of dyssynchrony between papillary muscles.…”

Moderate Chronic Ischemic Mitral Regurgitation

“…1) Surgical correction of moderate IMR at the time of coronary revascularization is still an unresolved controversy. [1][2][3][4][5][6][7][8][9] Coronary artery bypass grafting (CABG) alone did reduce MR at follow-up; nevertheless, CABG alone cannot be sufficient to eliminate MR. 3) Adding mitral valve annuloplasty to CABG may eliminate MR immediately after surgery; [10][11][12] however, recurrent MR did occur after CABG plus mitral valve annuloplasty, and no benefit for long-term survival was observed. [12][13][14] There was also a tendency toward higher morbidity and mortality in CABG plus mitral valve procedure as compared with CABG alone in high-risk patients with moderate IMR.…”