Key result
Concomitant mitral valve surgery during coronary artery bypass grafting did not significantly improve long-term all-cause mortality (HR 0.96) compared to CABG alone in patients with moderate ischemic mitral regurgitation.
Why the study?
Ischemic mitral regurgitation in patients undergoing CABG is associated with worse long-term outcomes, but the impact of concomitant mitral valve repair remains unclear.
Does concomitant mitral valve surgery improve long-term outcomes in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting?
Cohort (n=101)
No
Does concomitant mitral valve surgery improve long-term outcomes in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting?
In patients with moderate ischemic mitral regurgitation undergoing CABG, concomitant mitral valve surgery does not improve long-term survival or reduce MACCEs, but increases the risk of short-term complications like atrial fibrillation and need for blood transfusion.
Does not support routine concomitant mitral valve surgery for moderate ischemic MR during CABG; leaves open need for RCTs to confirm.
Objectives: Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. This study aimed to assess the impact of mitral valve repair with CABG in patients with moderate IMR. Materials: This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017. Methods: The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared. Results: Our database had 101 patients who underwent CABG with moderate IMR. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. Long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs were similar. Conclusion: Surgical treatment of moderate IMR combined with CABG was related to increased risk of several non-fatal short-term complications when compared to CABG alone, with similar long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.
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LEE et al. (2023) conducted a cohort in Moderate ischemic mitral regurgitation and multivessel coronary artery disease (n=101). Coronary artery bypass grafting with concomitant mitral valve surgery vs. Coronary artery bypass grafting alone was evaluated on Long-term all-cause mortality (HR 0.96, 95% CI 0.56-1.64, p=0.886). Concomitant mitral valve surgery during coronary artery bypass grafting did not significantly improve long-term all-cause mortality (HR 0.96) compared to CABG alone in patients with moderate ischemic mitral regurgitation.
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