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Concomitant Mitral Valve Surgery Versus No Intervention in Patients with Moderate Ischemic Mitral Regurgitation

Jiyoung Lee, Kan Kajimoto, Taira Yamamoto

    Juntendo Iji Zasshi = Juntendo Medical Journal
    |June 10, 2024
    PubMed

    Insights

    Adding mitral valve surgery (MVs) to coronary artery bypass grafting (CABG) for moderate ischemic mitral regurgitation (IMR) increases short-term complications but shows similar long-term outcomes. Further research is needed for severe cases.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Valvular Heart Disease

    Background:

    • Ischemic mitral regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is linked to poorer long-term prognoses.
    • Optimal management strategies for moderate IMR during CABG remain debated.

    Purpose of the Study:

    • To evaluate the impact of concurrent mitral valve surgery (MVs) with CABG on long-term outcomes in patients with moderate IMR.
    • To compare short-term and long-term results between CABG alone and CABG with MVs.

    Main Methods:

    • An observational study analyzed 3,215 patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease.
    • Propensity score matching was employed to compare outcomes between 40 pairs of patients undergoing CABG alone versus CABG with MVs.
    • Long-term endpoints included all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs).

    Main Results:

    • Mitral valve surgery (MVs) during CABG was associated with higher rates of postoperative atrial fibrillation, blood transfusions, and prolonged hospitalization.
    • Despite increased short-term complications, long-term outcomes, including all-cause mortality, cardiac mortality, and MACCEs, were similar between the two groups.
    • The analysis included 101 patients initially, with 40 matched pairs for the final comparison.

    Conclusions:

    • Combining MVs with CABG for moderate IMR increases non-fatal short-term complications compared to CABG alone.
    • Long-term survival and MACCEs appear comparable between CABG with MVs and CABG alone for moderate IMR.
    • Further investigation is warranted to clarify the role of MVs in patients with moderate IMR and severe coronary artery disease.
    Abstract

    Keywords:
    cardiac surgerycoronary artery bypass graftingischemic MR

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