The Effect of Treatment Strategy of Chronic Ischemic Mitral Regurgitation on Long-Term Outcomes in Coronary Artery Bypass Grafting

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 32; no. 6; pp. 508 - 516
• Main Authors: Şaşkin, Hüseyin, Ozcan, Kazım Serhan, İdiz, Mustafa
• Format: Journal Article
• Language: English
• Published: Sao Paulo Sociedade Brasileira de Cirurgia Cardiovascular 01.01.2017
• Subjects: CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiology; Cardiovascular disease; Coronary Artery Bypass; Coronary vessels; Heart surgery; Ischemia; Mitral Valve Annuloplasty; Mortality; Normal distribution; Original; Patients; Statistical analysis; Studies; SURGERY; Survival; Ultrasonic imaging; Coronary Artery Bypass; Mitral Valve Annuloplasty; Survival
• ISSN: 0102-7638; 1678-9741; 1678-9741
• DOI: 10.21470/1678-9741-2017-0001

Objective: To investigate the mid- and long-term outcomes of case-based selective strategy of mitral ring annuloplasty during coronary artery bypass grafting in patients with coronary artery disease accompanied by chronic ischemic mitral regurgitation. Methods: 132 patients who were diagnosed ischemic moderate to severe mitral regurgitation undergoing coronary artery bypass grafting in the same center with the same surgical team were divided into 2 groups and investigated retrospectively. Patients undergoing simultaneous mitral ring annuloplasty and coronary artery bypass grafting were enrolled to group 1 (n=58), patients undergoing isolated coronary artery bypass grafting were enrolled in group 2 (n=74). Results: The mean age of the patients were 65.0 ± 9.4 years and 39 (29.5%) of them were female. Preoperative New York Heart Association (NHYA) class (P=0.0001), atrial fibrillation (P=0.006) and the grade of mitral regurgitation (P=0.0001) were significantly different between the groups. Hospitalization for heart failure was required in 6 (10.6%) patients in group 1 and 19 (27.1%) patients in Group 2 (P=0.02). Hospital mortality and one-month postoperative mortality occurred in 2 (3.4%) patients in Group 1 and in 4 (5.4%) patients in Group 2 (P=0.69). Clinical follow-up was completed with 117 (88.6%) patients. Conclusion: Mitral ring annuloplasty in addition to the coronary artery bypass grafting is associated with improved NYHA functional class, increased ejection fraction, decreased residual mitral regurgitation. Further studies are needed to clarify the role of combined surgery on long-term outcomes. With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed. Keywords: Coronary Artery Bypass; Mitral Valve Annuloplasty; Survival Abbreviations, acronyms & symbols ACE = Angiotensin-converting-enzyme LVEDD = Left ventricle end-diastolic diameter ACT = Activated clotting time LVEDV = Left ventricle end-diastolic volume AF = Atrial fibrillation LVEF = Left ventricular ejection fraction CABG = Coronary artery bypass grafting LVESD = Left ventricle end-systolic diameter CPB = Cardiopulmonary bypass LVESV = Left ventricle end-systolic volume ECG = Electrocardiography MRA = Mitral ring annuloplasty EF = Ejection fraction NYHA = New York Heart Association EROA = Effective regurgitant orifice area PAP = Pulmonary arterial pressure IMI = Ischemic mitral valve insufficiency PISA = Proximal isovelocity surface area IMR = Ischemic mitral regurgitation RV = Regurgitant volume LIMA = Left internal mammary artery TTE = Transthoracic echocardiography LV = Left ventricle