Amber Malhotra1, Pankaj Garg2, Sumbul Siddiqui3, Komal Shah4. 1. Department of cardiothoracic Surgery, Baylor Scott and White Health, Temple, TX, 76508, USA. 2. Départment of Cardiothoracic and Vascular Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA. drpnkjgarg104@gmail.com. 3. Department of cardiothoracic surgery, Datta Maghe Institute of Medical Sciences Sawangi (Meghe), Wardha, 442004, Maharashtra, India. 4. Indian Institute of Public health Gandhinagar, Gandhinagar, 382042, Gujarat, India.
Abstract
OBJECTIVE: Current evidence does not allow a consensus on the management of moderate chronic ischemic mitral regurgitation (CIMR). We compared moderate CIMR patients undergoing off-pump CABG (OPCABG) alone and CABG + MV repair for early mortality, major adverse systemic events (MASE) and mid-term functional outcomes. METHODS: 210 patients with moderate CIMR who underwent off-pump coronary artery bypass grafting (OPCABG) Group I (n = 106) or CABG + mitral valve repair (MV rep) Group II (n = 104) were followed prospectively. For comparison, patients were further sub-divided based on the product of regurgitant fraction and ejection fraction "RFEF"(Good/Bad) and MR jet direction (Central/Eccentric). The primary end point of the study was mortality and secondary end points were MASE, percentage improvements in indexed left ventricle end-systolic volume (LVESVI %), MR grade and functional outcomes of the patients. RESULTS: In-hospital and overall mortality was significantly lower in Group I (1.89% vs. 13.46%, p < 0.001 and 5.66% vs. 15.38%; p = 0.024 respectively). Group II had significantly higher MASE, ventilation time, mean ICU and hospital stay. At 36 months, LVESVI% (17.56% ± 9.12% vs. 18.81% ± 7.48%; p = 0.279), MR grade improvement (80.18% vs. 83.50%; p = 0.544), NYHA class and MLHF scores were also similar in both groups. On subgroup analysis, Good RFEF with Central jet subgroup had comparable improvement in LVESVI% and MR grade with either procedure, while Bad Eccentric subgroup showed a significantly higher improvement in LVESVI% and MR grade with CABG + MV repair. CONCLUSION: OPCABG is associated with significantly reduced mortality and MASE with comparable improvement in LVEDVI% and MR grade. CABG + MV Rep results in significant improvement in LVEDVI% and MR grade in patients with bad eccentric MR. The recommended procedures in the "Good Central" and "Bad Eccentric" subsets are CABG and CABG + Mvrepair, respectively.
OBJECTIVE: Current evidence does not allow a consensus on the management of moderate chronic ischemic mitral regurgitation (CIMR). We compared moderate CIMR patients undergoing off-pump CABG (OPCABG) alone and CABG + MV repair for early mortality, major adverse systemic events (MASE) and mid-term functional outcomes. METHODS: 210 patients with moderate CIMR who underwent off-pump coronary artery bypass grafting (OPCABG) Group I (n = 106) or CABG + mitral valve repair (MV rep) Group II (n = 104) were followed prospectively. For comparison, patients were further sub-divided based on the product of regurgitant fraction and ejection fraction "RFEF"(Good/Bad) and MR jet direction (Central/Eccentric). The primary end point of the study was mortality and secondary end points were MASE, percentage improvements in indexed left ventricle end-systolic volume (LVESVI %), MR grade and functional outcomes of the patients. RESULTS: In-hospital and overall mortality was significantly lower in Group I (1.89% vs. 13.46%, p < 0.001 and 5.66% vs. 15.38%; p = 0.024 respectively). Group II had significantly higher MASE, ventilation time, mean ICU and hospital stay. At 36 months, LVESVI% (17.56% ± 9.12% vs. 18.81% ± 7.48%; p = 0.279), MR grade improvement (80.18% vs. 83.50%; p = 0.544), NYHA class and MLHF scores were also similar in both groups. On subgroup analysis, Good RFEF with Central jet subgroup had comparable improvement in LVESVI% and MR grade with either procedure, while Bad Eccentric subgroup showed a significantly higher improvement in LVESVI% and MR grade with CABG + MV repair. CONCLUSION: OPCABG is associated with significantly reduced mortality and MASE with comparable improvement in LVEDVI% and MR grade. CABG + MV Rep results in significant improvement in LVEDVI% and MR grade in patients with bad eccentric MR. The recommended procedures in the "Good Central" and "Bad Eccentric" subsets are CABG and CABG + Mvrepair, respectively.
Authors: Robert O Bonow; Blase A Carabello; Kanu Chatterjee; Antonio C de Leon; David P Faxon; Michael D Freed; William H Gaasch; Bruce W Lytle; Rick A Nishimura; Patrick T O'Gara; Robert A O'Rourke; Catherine M Otto; Pravin M Shah; Jack S Shanewise; Rick A Nishimura; Blase A Carabello; David P Faxon; Michael D Freed; Bruce W Lytle; Patrick T O'Gara; Robert A O'Rourke; Pravin M Shah Journal: J Am Coll Cardiol Date: 2008-09-23 Impact factor: 24.094
Authors: Peter K Smith; John D Puskas; Deborah D Ascheim; Pierre Voisine; Annetine C Gelijns; Alan J Moskowitz; Judy W Hung; Michael K Parides; Gorav Ailawadi; Louis P Perrault; Michael A Acker; Michael Argenziano; Vinod Thourani; James S Gammie; Marissa A Miller; Pierre Pagé; Jessica R Overbey; Emilia Bagiella; François Dagenais; Eugene H Blackstone; Irving L Kron; Daniel J Goldstein; Eric A Rose; Ellen G Moquete; Neal Jeffries; Timothy J Gardner; Patrick T O'Gara; John H Alexander; Robert E Michler Journal: N Engl J Med Date: 2014-11-18 Impact factor: 91.245
Authors: Yong-Hwan Kim; Lawrence S C Czer; Harmik J Soukiasian; Michele De Robertis; Kathy E Magliato; Carlos Blanche; Sharo S Raissi; James Mirocha; Robert J Siegel; Robert M Kass; Alfredo Trento Journal: Ann Thorac Surg Date: 2005-06 Impact factor: 4.330
Authors: Sorel Goland; Lawrence S C Czer; Robert J Siegel; Michele A DeRobertis; James Mirocha; Kaveh Zivari; Robert M Kass; Sharo Raissi; Gregory Fontana; Wen Cheng; Alfredo Trento Journal: Tex Heart Inst J Date: 2009
Authors: L Menicanti; M Di Donato; A Frigiola; G Buckberg; C Santambrogio; M Ranucci; D Santo Journal: J Thorac Cardiovasc Surg Date: 2002-06 Impact factor: 5.209