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Concomitant mitral valve surgery in patients with moderate ischemic mitral regurgitation undergoing coronary artery

Byung Jin Kim1, Yun Seok Kim2, Ho Jin Kim3

  • 1Medical Sciences Division, University of Oxford, Oxford, UK.

Journal of Thoracic Disease
|August 3, 2018
PubMed

Insights

Adding mitral valve surgery to coronary artery bypass grafting for moderate ischemic mitral regurgitation increases early risks. Long-term benefits are not significant, suggesting CABG alone may be preferable for these patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Disease

Background:

  • The clinical benefit of concurrent mitral valve (MV) surgery with coronary artery bypass grafting (CABG) for moderate ischemic mitral regurgitation (iMR) is debated.
  • Understanding the risks and benefits is crucial for patient management.

Purpose of the Study:

  • To evaluate the impact of concomitant MV surgery on outcomes in patients with moderate iMR undergoing CABG.
  • To compare early and long-term clinical and echocardiographic results between CABG-only and CABG with MV surgery.

Main Methods:

  • A cohort of 710 patients with moderate iMR undergoing CABG (1990-2015) was analyzed.
  • 116 patients (16.3%) had concomitant MV surgery (MVS), while 594 (83.7%) had CABG only.
  • Propensity score matching was used to adjust for baseline differences and compare outcomes.

Main Results:

  • Concomitant MV surgery was associated with increased early mortality, low cardiac output syndrome, and surgical bleeding.
  • After adjustment, the risk of early death remained significantly higher in the MVS group.
  • Long-term survival showed a trend towards increased mortality with MVS, but this difference diminished at 1 year post-surgery.
  • Both groups showed similar improvements in left ventricular ejection fraction and reverse remodeling.

Conclusions:

  • Concomitant MV surgery in moderate iMR patients undergoing CABG increases early mortality and complication risks.
  • No significant long-term clinical or echocardiographic benefits were observed with the addition of MV surgery.
  • CABG alone may be a safer option for selected patients with moderate iMR.
Abstract

Keywords:
Ischemic mitral regurgitation (iMR)coronary artery bypass grafting (CABG)mitral valve surgeryv

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