Off-Pump Revascularization in Moderate Ischemic Mitral Regurgitation

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Interventional Cardiology

Background:

• Ischemic mitral regurgitation (IMR) presents a significant challenge due to high mortality and debated surgical management strategies for moderate cases.
• Off-pump coronary artery bypass grafting (OPCAB) is an alternative surgical approach.
• The efficacy of OPCAB in patients with moderate IMR requires further investigation.

Purpose of the Study:

• To evaluate the outcomes of isolated off-pump coronary bypass grafting (OPCAB) with facile stabilization in patients with moderate ischemic mitral regurgitation (IMR).
• To identify predictors of mortality and major adverse events in this patient cohort.

Main Methods:

• Retrospective analysis of 62 patients with moderate IMR undergoing isolated OPCAB between January 2015 and February 2022.
• Primary endpoint: assessment of residual IMR and echocardiographic changes.
• Secondary endpoints: mortality, major adverse events, and postoperative functional status.

Main Results:

• Regurgitation regressed in 58.06% of patients.
• Postoperative left atrial (LA) diameter decreased significantly, with increased LA diameter predicting major adverse events.
• Higher rehospitalization rates were observed in patients with low ejection fraction (EF).
• Poor functional status correlated with increased left ventricular end-systolic diameter (LVESD).
• Mortality was associated with older age and increased systolic pulmonary artery pressure (PAP).

Conclusions:

• Left atrial diameter, LVESD, mean systolic PAP, LVEF, and age are crucial predictors of outcomes in IMR.
• Residual IMR was not directly correlated with increased mortality or major adverse cardiac and cerebrovascular events.
• The facile stabilization technique facilitated complete revascularization and provided excellent surgical vision without cardiac compression.