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

Abstract

ObjectiveTo 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.Methods132 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).ResultsThe 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.ConclusionMitral 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.

Coronary artery bypass on survival in patients with moderate ischemic mitral regurgitation: meta-analysis

“…There are 1466 documents were initially retrieved, remove the irrelevant research, review and repetitive literature by reading the article title and abstract. Finally, 4 randomized controlled studies and 15 retrospective controlled studies were included in the study from 2001 to 2018 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . A total of 4476 patients were enrolled in this study, including 2778 patients in CABG group and 1698 patients in CMVs group.…”

“…The 16 studies [4][5][6][7][8][9][10][11][12][13][15][16][17][18]20 reported perioperative mortality after surgery, and the results showed statistical heterogeneity (p = 0.06, I 2 = 38%), so the random effect model was used for meta-analysis. The results showed that there was no significant difference in perioperative mortality between CABG group and CMVs Group (odds ratio [OR] = 0.88, 95% confident interval [CI] [0.54, 1.44], p = 0.62) (Fig.…”

“…The 11 studies 5,9,14,16,17 reported the survival rate of 1-3 years after surgery, and the results of each study were not statistically heterogeneous (p = 0.41, I 2 = 2%), so the fixed effect model was used for meta-analysis. The results showed that there was no significant difference in 1-3-year survival rate between CABG group and cMVS group (OR = 1.07, 95% CI [0.83, 1.37], p = 0.62) (Fig.…”