Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis (original) (raw)
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Introduction: The combination of mitral valve replacement (MVR) with coronary artery bypass grafting (CABG) is generally thought to have a greater early and late mortality than either procedure alone. The aim of this study is to review single center experience for the concomitant MVR and CABG. Patients and methods: This is a single center, retrospective, single cohort study, composes of consecutive cases. It included all the cases of combined operation of MVR and CABG. The patients were followed up for a median duration of two years (six months to four years). The data were collected from hospital records and registers of hospital statistics. The followings were obtained; socio-demographic data, information regarding clinical courses, intraoperative findings, and post-operative follow up data. Result: The study included 72 cases, the mean age was 56 years, 38 of them (53%) were males and 34 (47%) were female. The most common comorbidity was hypertension which was found in 24 patients (33%). The mean preoperative ejection fraction was 59%. Twenty-two patients (30.6%) had single graft, 21 patients (29.2%) underwent 3-vessel grafting, 16 patients (22.2%) had 2-vessel grafting, and 13 cases (18.1%) underwent 4-vessel grafting. The CPB duration ranged from 108 to 280 min with a mean of 182 min and cross-clamp time ranged from 80 to 186 min with a mean of 122 min. The most common complication was plural effusion which occurred in 8 cases (11.1%) and managed by aspiration. Overall mortality was 8.3% (4 patients). Conclusion: CABG and chordal-sparing and posterior leaflet replacement has favorable outcome, as well as minimizes the need of redo surgery as in repair.one of the best options for CAD and sever MR.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2013
Ischemic mitral regurgitation (IMR) is associated with increased mortality. Even after coronary artery bypass grafting (CABG), IMR reduces survival. Several studies have shown increased perioperative mortality for mitral valve replacement (MVR) in this situation, but the subject remains controversial. To investigate the impact of MVR on immediate outcomes in patients with moderate-to-severe IMR undergoing concomitant CABG compared with those undergoing CABG only. We performed a retrospective study of 42 patients undergoing CABG+MVR (n=16) or CABG only (n=26) at the Division of Cardiovascular Surgery of PROCAPE, between May 2007 and April 2010. Preoperative clinical characteristics, procedural characteristics, major and minor complications after surgery, preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography, and outcome (survivor or death) were assessed. Mean patient age was 63.4 ± 8.5 years, and 64.8% (n=23) were male. The CABG+MVR group showed...
Frontiers in Cardiovascular Medicine
AimsPatients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database.Methods and resultsThe National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016–2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. A...
The Annals of thoracic surgery, 2016
For mitral regurgitation (MR) from degenerative mitral disease in patients with coexisting coronary artery disease, the appropriate surgical strategy remains controversial. From 1985 to 2011, 1,071 adults (age 70 ± 9.3 years, 77% men) underwent combined coronary artery bypass grafting and either mitral valve repair (n = 872, 81%) or replacement (n=199, 19%) for degenerative MR. Propensity matching (177 patient pairs, 89% of possible matches) was used to compare early outcomes and time-related recurrence of MR after mitral valve repair, mitral valve reoperation, and mortality. Risk factors for death were identified with multivariable, multiphase hazard-function analysis. Patients undergoing valve replacement were older, with more valve calcification and a higher prevalence of preoperative atrial fibrillation and heart failure (all p < .0001). Among matched pairs, mitral replacement versus repair was associated with higher hospital mortality (5.0% vs 1.0%, p = .0001) and more posto...
Circulation, 2003
A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement. A matched study was performed using prospectively collected data from the Emory cardiovascular database from 1984 to 1997 comparing 625 MV repair patients with 625 MV replacement patients. Mean age was significantly higher in the replacement group (56+/-14 versus 55+/-14 years). Preoperative demographics and postoperative outcomes were similar between groups. Length of stay (LOS) was significantly less in the repair group (9.5+/-9.4 versus 12.3+/-13.1 days). In-hospital mortality was significantly less in the repair group (4.3% versus 6.9%), and overall 10-year survival was significantly higher in the repair group (62% versus 46%). Ten-year survival of patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 years of age was significantly higher in repair patients (81% versus 55%) but similar in patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =60 years of age (33% versus 36%, respectively). Ten-year survival of MV repair without CABG was significantly higher compared with MV replacement patients (74% versus 51%) but similar to patients with concomitant CABG (28% versus 34%, respectively). Independent predictors of long-term mortality included increasing age, urgent/emergent status, female sex, diabetes mellitus, increasing weight, heart failure, decreasing ejection fraction, concomitant CABG, and MV replacement. Mitral valve repair has reduced LOS and improved in-hospital and 10-year survival. However, in the present series, MV repair does not provide significant long-term survival benefit over MV replacement in patients older than 60 years of age or those requiring concomitant CABG.