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La revascularización quirúrgica se asocia con la supervivencia máxima en pacientes con regurgitación mitral

Anthony W Castleberry¹, Judson B Williams¹, Mani A Daneshmand¹

¹From the Department of Surgery; The Division of Cardiovascular and Thoracic Surgery (A.W.C., J.B.W., M.A.D., C.A.M., P.K.S.); Duke Clinical Research Institute (J.B.W., E.H., L.K.S., R.D.L., J.H.A., E.J.V.); Department of Medicine, Division of Cardiology (Z.S., R.D.L., J.H.A., E.J.V.); and Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine (J.P.M.), Duke Medicine, Durham, NC.

|April 19, 2014

Resumen

Para los pacientes con regurgitación mitral isquémica y enfermedad de las arterias coronarias, el injerto de derivación de la arteria coronaria (CABG) por sí solo ofrece el riesgo de mortalidad más bajo. CABG, con o sin cirugía de válvula, mejora la supervivencia en comparación con otros tratamientos.

Área de la Ciencia:

Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
Cardiología Intervencionista Cardiología intervencionista.
Resultados clínicos Investigación de resultados clínicos.

Sus antecedentes:

Se debate el tratamiento óptimo para la regurgitación mitral isquémica (RMI).
IMR a menudo coexiste con una enfermedad arterial coronaria significativa (CAD).

Objetivo del estudio:

Evaluar la relación entre las estrategias de tratamiento de la RMI y la supervivencia del paciente.
Para comparar los resultados del manejo médico, PCI, CABG y CABG combinado con intervención valvular.

Principales métodos:

Revisión retrospectiva de 4989 pacientes con CAD significativo y RMI moderada / severa (1990-2009).
Grupos de tratamiento: terapia médica, intervención coronaria percutánea (PCI), injerto de derivación de la arteria coronaria (CABG) y CABG más cirugía de válvula mitral.
Análisis de supervivencia utilizando modelos de Kaplan-Meier y Cox multivariables con ajuste de propensión al puntaje.

Principales resultados:

El CABG solo (33% de los pacientes) mostró una mortalidad significativamente menor que el tratamiento médico solo (36%).
La ICP (26%) también demostró una reducción de la mortalidad en comparación con la terapia médica.
CABG más cirugía de la válvula mitral (5%) tuvo una menor mortalidad que la terapia médica y la ICP, pero no significativamente diferente de CABG solo.
No hay diferencias significativas en los resultados basados en la gravedad de la RMI.

Conclusiones:

El injerto de derivación de la arteria coronaria (CABG) solo se asocia con el riesgo de mortalidad más bajo en pacientes con CAD e IMR significativos.
CABG, con o sin intervención de la válvula mitral, ofrece una supervivencia superior en comparación con la intervención coronaria percutánea o el manejo médico solo.

Palabras clave:

La isquemia por isquemia es una enfermedad La válvula mitral tiene revascularización y revascularización.El stent es un stent.

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