Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery?

Salmasi, Mohammad Yousuf; Harky, Amer; Chowdhury, Mohammed F.; Abdelnour, Ali; Benjafield, Anastasia; Suker, Farah; Hubbard, Stephanie J.; Vohra, Hunaid A.

doi:10.1111/jocs.13722

Cited by 16 publications

(18 citation statements)

References 35 publications

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“…schemic mitral regurgitation (IMR) is a complication of myocardial infarction (MI) and/or myocardial ischemia, causing left ventricular remodeling. [1][2][3] The development of IMR is associated with increased risk of heart failure and mortality, and these risks increase with the severity of regurgitation. 4) Surgical correction of moderate IMR at the time of coronary revascularization is still an unresolved controversy.…”

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confidence: 99%

“…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.…”

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confidence: 99%

“…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.…”

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confidence: 99%

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

Zhao

Shen

et al. 2019

Int. Heart J.

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Few reports have focused on which patients with moderate ischemic mitral regurgitation (IMR) were not good candidates for coronary artery bypass grafting (CABG) alone. This single-center study aimed to assess risk factors for moderate or more residual regurgitation within two years after CABG alone for the treatment of moderate chronic IMR to optimize the operation strategy and prognosis. A total of 189 eligible patients were entered into a failure group (n = 108) or an improved group (n = 81) according to whether moderate or more residual regurgitation occurred within two years after surgery. Baseline and surgical characteristics were analyzed, and clinical outcomes were compared between groups. Prior myocardial infarction (MI)/chronic myocardial ischemia and region wall motion abnormality (anterior/inferior-posterior wall) were two independent risk factors for moderate or more residual regurgitation, following CABG alone, for the treatment of moderate chronic IMR (OR = 3.15, 95% CI 1.66-5.75, and OR = 2.45, 95% CI 1.36-4.84, respectively). During a median follow-up of 40 months, compared with the improved group, the failure group was more likely to present with New York Heart Association (NYHA) class III-IV and cardiac re-hospitalization (57.4% versus 11.1%, P < 0.001, and 13.9% versus 4.9%, P = 0.043, respectively) and had worse cumulative survival (χ 2 = 4.259, log-rank P = 0.039). Patients suffering from moderate chronic IMR secondary to prior MI (rather than chronic ischemia) with anterior wall motion abnormalities (rather than inferior-posterior wall motion abnormalities) may not be good candidates for CABG alone, and may have a poor prognosis after CABG alone.

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

Zhao

Shen

et al. 2019

Int. Heart J.

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“…Another recent meta‐analysis showed that in the presence of moderate ischemic MR, adding a MVr in addition to a coronary artery bypass graft decreased the degree of MR and promoted ventricular remodeling. However, there was no improvement in long‐term survival or functional class . Other subtypes of mitral valve disease remain controversial as well, such as rheumatic disease and endocarditis .…”

Section: Discussionmentioning

confidence: 97%

“…However, there was no improvement in long-term survival or functional class. 23 Other subtypes of mitral valve disease remain controversial as well, such as rheumatic disease and endocarditis. 3,11 In a recent meta-analysis, while patients undergoing a…”

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confidence: 99%

Outcomes of mitral valve surgery during concomitant aortic valve replacement

et al. 2018

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Background This study evaluates outcomes of mitral valve surgery (MVS), replacement (MVR), and repair (MVr), during concomitant aortic valve replacement (AVR). Methods Patients undergoing MVS with concomitant AVR between 2011 and 2017 at a single center were reviewed. Patients were stratified into MVR versus MVr with concomitant AVR. Outcomes included early and midterm mortality, hospital re‐admissions, re‐operations, and complications. Multivariable Cox regression analysis was used for risk‐adjustment. Results Four hundred twenty‐four patients underwent MVS with concomitant AVR: 247 (58.3%) MVr and 177 (41.7%) MVR. In unadjusted analysis, there was a non‐significant increase in 30‐day mortality with MVR, with no differences in 1‐ and 5‐year mortality (30‐day: 5.6% vs 10.1%, P = 0.081; 1‐year: 14% vs 18.2%, P = 0.181; 5‐year: 35.1% vs 37.8%, P = 0.232). Freedom from re‐admission and mitral reoperation were comparable. Freedom from at least moderate mitral regurgitation at 5 years was 78% in MVr patients. Those undergoing MVR had increased postoperative blood transfusions, acute renal failure, and pleural effusions requiring drainage (P each <0.05). Conclusions MVr can be performed during concomitant AVR without an adverse impact on longer‐term outcomes, including mortality, re‐admissions, and mitral reoperations. The majority of patients have durable repairs at 5 years although durability is less than that reported in isolated MVS.

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20 Years of triple-valve surgery in the UK: demographic and outcome trends

Al-Zubaidi,

Hussein,

Smith

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES To describe evolving demographic trends and early outcomes in patients undergoing triple-valve surgery in the UK between 2000 and 2019. METHODS We planned a retrospective analysis of national registry data including patients undergoing triple-valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort. RESULTS We identified 1750 patients undergoing triple-valve surgery in the UK between 2000 and 2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 ± 12 years, having increased from 63 ±12 years in group A to 69 ± 12 years in group E (P < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (P < 0.001). Overall rates of re-exploration for bleeding (11%, P = 0.308) and postoperative dialysis (11%, P = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality. CONCLUSIONS Triple-valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.

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Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery?

Abstract: Our results show that in the presence of moderate IMR, adding MVr to revascularization reduces MR grade on follow-up echocardiography and promotes ventricular remodeling, with no improvement in long-term survival or functional class.

Cited by 16 publications

References 35 publications

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

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

Outcomes of mitral valve surgery during concomitant aortic valve replacement

20 Years of triple-valve surgery in the UK: demographic and outcome trends

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