Midterm Outcomes of Isolated Coronary Artery Bypass Grafting in the Setting of Moderate Ischemic Mitral Regurgitation

Seese, Laura; Deitz, Rachel L.; Dufendach, Keith; Sultan, Ibrahim; Aranda‐Michel, Edgar; Gleason, Thomas G.; Wang, Yisi; Thoma, Floyd; Kilic, Arman

doi:10.1016/j.jss.2022.04.043

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…The observed reduction of mitral regurgitation grade, which has been already described after CABG [18][19][20][21], may thus be the consequence of the concurrent contribution of left ventricular reverse remodeling and the changes of mitral valve reserve, with stable results up to 2 years.…”

Section: Discussionmentioning

confidence: 56%

Analysis of changes in “mitral valve reserve” after coronary artery bypass grafts in patients with functional mitral regurgitation

Ceresa

Micari²,

Rubino

et al. 2022

J Cardiothorac Surg

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Introduction The treatment of moderate functionalmitral regurgitation (FMR) during coronary artery bypass grafting (CABG) is still debated. Our primary end point was to assess the improvement of “mitral valve reserve” (MVR) after CABG alone as a clinical demonstration of left ventricular (LV) recovery. Materials and methods Between June 2019 and June 2021, we prospectively enrolled 104 consecutive patients undergoing CABG with moderate FMR. Inclusion criteria were inferior-posterior-lateral wall hypokinesia and revascularization of the circumflex or right coronary artery. MVR was calculated as the ratio between anterior and posterior leaflets’ straight length. All patients were followed for 1 year. The improvement of MVR has been considered as a reduction of the ratio between anterior and posterior leaflets straight length. Results Compared to baseline, mean MVR was significantly reduced both at 6 (2.24 ± 0.95 vs. 1,91 ± 0.6; p = 0,047) and 12 months follow-up (2.24 ± 0.95 vs. 1,69 ± 0.49; p = 0,006). Left ventricular (LV) reverse remodeling, meant as improvement of LV ejection fraction and reduction of LV end-systolic volume index and mitral anulus diameter were evaluated at 6 months and 1 year. Mitral regurgitation grade were also significantly reduced at 6 months (p < .001). Conclusion The benefits of myocardial revascularization in term of improvement of mitral regurgitation’s degree can be explained by the changes of MVR. The patients with FMR, who could have more advantages from CABG alone, should be the ones who have LVESVi just moderately increased.

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Section: Discussionmentioning

confidence: 56%

Analysis of changes in “mitral valve reserve” after coronary artery bypass grafts in patients with functional mitral regurgitation

Ceresa

Micari²,

Rubino

et al. 2022

J Cardiothorac Surg

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“…However, the optimal management of moderate IMR during CABG remains controversial. Some surgeons prefer CABG alone for moderate IMR, because revascularization can improve regional and global left ventricular function and subsequently reduce severity of MR. 3 Sine mitral valve (MV) surgery directly reduce the degree of MR, others prefer the addition of MV procedure (repair or replacement) to CABG, and correction of MR might prevent further adverse remodeling and reduce the risk of heart failure. 4 Nevertheless, CABG combined with MV surgery is associated with a longer duration of cardiopulmonary bypass, which can increase risk of perioperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Should moderate ischemic mitral regurgitation be corrected during coronary artery bypass grafting? a systematic review and meta‐analysis

Zhang

2022

Perfusion

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Objective Ischemic mitral regurgitation (IMR) is associated with increased risks of mortality and heart failure. However, the optimal management of moderate IMR remains controversial. We conducted a meta-analysis to appraise whether moderate IMR should be corrected during coronary artery bypass grafting (CABG). Methods We searched PubMed, Embase, and Cochrane databases from its inception up to 15 October 2022 for studies that assessed CABG alone versus CABG with mitral valve (MV) surgery in patients with moderate IMR. The primary outcome was perioperative mortality. Results Four randomized controlled trials and three observational studies with propensity-matched data including 1209 patients assessing CABG alone ( n = 598) versus CABG with MV surgery ( n = 611) were included. Compared to CABG alone, the addition of MV surgery did not significantly increase perioperative mortality (RR, 1.01; 95% CI, 0.52–1.96; p = 0.98) and stroke (RR, 2.14; 95% CI, 0.97–4.72; p = 0.06), whereas a longer cardiopulmonary bypass duration (MD, 54.91; 95% CI, 42.13–67.68; p < 0.01) and an increased incidence of renal failure were observed in the combined-procedure group. At follow-up, the addition of MV surgery was significantly associated with reduced rates of residual MR (RR, 0.26; 95% CI, 0.13–0.51; p < 0.01) and NYHA class III-IV (RR, 0.54; 95% CI, 0.37–0.78; p < 0.01). However, there was no difference in either mid-term mortality (RR, 1.05; 95% CI, 0.65–1.70; p = 0.82) or late mortality (RR, 91; 95% CI, 0.49–1.71; p = 0.78) between the CABG alone group and the combined-procedure group. Conclusions In patients with moderate IMR, the addition of MV surgery to CABG did not increase perioperative mortality. Despite the reduced rates of moderate MR and NYHA class III-IV at follow-up, the addition of MV surgery did not translate in a reduction in mid-term or late mortality.

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Modern challenges of surgical management of patients with moderate and borderline ischemic mitral regurgitation

Ryadinsky,

Filippov,

Kamenskikh

et al. 2024

SJCEM

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One of the most common complications of ischemic heart disease is ischemic mitral regurgitation (IMR). About 20% of patients with coronary artery disease suffer from the onset and progression of IMR. It is more often observed in patients who have suffered a myocardial infarction of the inferior wall of the left ventricle (LV). It is known that the presence of mitral regurgitation (MR) reduces patient survival regardless of the presence of ischemic heart disease. The accumulated experience in the field of diagnosis and tactics of surgical treatment of IMR is currently ambiguous, despite many studies being conducted. In particular, such important problems as determining predictors and risk factors for recurrent IMR after surgical treatment, as well as indications for mitral valve intervention and the choice of surgical technique for correcting moderate and borderline IMR remain unresolved. Determining the risk factors for an unfavorable outcome of each specific method of surgical treatment of borderline IMR will help the specialists make the right decision regarding the treatment of this pathology. This literature review shows the full range of modern surgical methods for the treatment of borderline ischemic mitral dysfunction, evaluates the results of the most common isolated and combined operations, analyzes the risk factors for unfavorable outcome in the long-term period after their implementation, and also offers original approaches to the tactics of surgical treatment of IMR.

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Midterm Outcomes of Isolated Coronary Artery Bypass Grafting in the Setting of Moderate Ischemic Mitral Regurgitation

Cited by 3 publications

References 17 publications

Analysis of changes in “mitral valve reserve” after coronary artery bypass grafts in patients with functional mitral regurgitation

Analysis of changes in “mitral valve reserve” after coronary artery bypass grafts in patients with functional mitral regurgitation

Should moderate ischemic mitral regurgitation be corrected during coronary artery bypass grafting? a systematic review and meta‐analysis

Modern challenges of surgical management of patients with moderate and borderline ischemic mitral regurgitation

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