Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone
J M Arcidi1, R F Hebeler, J M Craver
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
Insights
Coronary bypass alone is a safe and effective treatment for moderate mitral regurgitation and coronary disease, improving patient function and survival without high operative mortality. This approach avoids the risks associated with combined valve replacement and bypass surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Treatment
Background:
- Moderate mitral regurgitation (MR) often coexists with coronary artery disease (CAD).
- Combined mitral valve replacement (MVR) and coronary bypass grafting (CABG) historically carry high operative mortality.
- Coronary bypass alone is considered for patients with moderate MR and CAD due to surgical risks.
Purpose of the Study:
- To evaluate the outcomes of treating moderate MR and CAD with coronary bypass surgery alone.
- To compare the results with combined MVR and CABG in a similar patient cohort.
Main Methods:
- Retrospective analysis of 58 patients undergoing CABG alone for moderate MR and CAD (1977-1983).
- Comparison with 20 unmatched patients who underwent combined MVR and CABG during the same period.
- Assessment of hospital mortality, functional status, return to work, and long-term survival.
Main Results:
- CABG alone group: 3.4% hospital mortality, 77% 5-year survival.
- Post-CABG alone: 66% of survivors improved to functional classes I/II (vs. 7% preoperatively).
- 84% of employed patients returned to work; no reoperations needed.
- Combined MVR and CABG group: 25% hospital mortality, 31% 5-year survival.
Conclusions:
- Coronary bypass alone is a viable strategy for moderate MR and CAD, offering excellent hospital survival.
- This approach leads to significant long-term functional improvement and survival without the need for subsequent valve surgery.
- Surgical intervention with CABG alone demonstrates superior outcomes compared to combined MVR and CABG in selected patients.
Abstract:
We have favored treatment of moderate mitral regurgitation and coronary disease with coronary bypass alone because of the high operative mortality of combined mitral valve replacement and coronary bypass. Between 1977 and 1983, coronary bypass alone was performed on 58 patients (mean age 63 +/- 8 years). Preoperatively, 90% had Canadian Cardiovascular Society class III or IV angina, and 10% had class III or IV congestive heart failure. In 72% mitral regurgitation had been caused by coronary disease. Hospital mortality was 3.4% (2/58). At follow-up (100% complete, mean 4.3 years) 66% of survivors were functional classes I and II (compared with 7% preoperatively, p less than 0.0001). Of those patients who worked preoperatively, 84% returned to work. There were no reoperations. The 5-year survival was 77%. In the same period combined mitral valve replacement and coronary bypass was required in 20 unmatched patients with moderate mitral regurgitation and coronary disease. Indications for valve replacement included congestive heart failure (10 cases), high left atrial pressure (three cases), and mitral stenosis (four cases). In these patients with more advanced symptoms the hospital mortality was 25%, and the 5-year survival was 31%. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone achieved excellent hospital survival and long-term functional stability without a subsequent valve operation.
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