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

Abstract

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.

Obstructive Coronary Artery Disease in Patients Undergoing Rheumatic Valvular Heart Surgery

“…2 Among various other factors, the presence of concomitant obstructive coronary artery disease (CAD) in patients with rheumatic VHD is found to be associated with an increased risk of adverse clinical outcomes and complications. [3][4][5][6][7] CAD is more common among patients with degenerative or calcific valvular lesions due to shared pathophysiological risk factors such as hypertension, smoking, lipid deposition, inflammatory processes, and aging. [8][9][10][11] The reported prevalence of concomitant CAD varies from the smallest of 9% to as high as 41% depending on the size of the sample, type of the VHD, and definition of CAD used by these studies.…”

Cystatin C to Left Ventricular Ejection Fraction Ratio as a Novel Predictor of Adverse Outcomes in Patients with Coronary Artery Disease: A Prospective Cohort Study

“…In China, the incidence of CAD is increasing annually [ 2 ]. Although several predictors of CAD-related death have been reported [ 3 , 4 , 5 , 6 ], more powerful predictors need to be developed.…”