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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 10/2023

28-03-2023 | Heart Failure | Original Article

Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate–severe ischemic mitral regurgitation

Authors: Kaoru Matsuura, Hiraku Kumamaru, Goro Matsumiya, Noboru Motomura

Published in: General Thoracic and Cardiovascular Surgery | Issue 10/2023

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Abstract

Background

Operative indication of the additional mitral repair for moderate ischemic mitral regurgitation (MR) in the setting of coronary artery bypass grafting (CABG) is still unclear.

Methods

This study was designed as the nation-wide multi-center retrospective analysis with additional survival data. CABGs without past heart surgery registered in 2014 and 2015 were included. Concomitant surgery other than tricuspid or arrhythmia surgery, mitral replacement, and off-pump cases, was excluded. Grade 1 or 4 MR, and ejection fraction < 20 or > 50 were excluded. Additional questionnaire was sent to each hospital, regarding the pathology of MR and clinical outcomes. Additional data were registered between May 28, 2021 and Dec 31, 2021, and the primary outcomes were all-death and cardiac death. The secondary outcomes were heart failure and cerebrovascular event requiring admission, mitral re-intervention. Patients underwent on-pump CABG (CABG only group 221 cases) and CABG with mitral repair (CABG + Mitral repair group 276 cases) were enrolled.

Results

After Propensity score matching, 362 cases (CABG only 181cases vs CABG + mitral repair 181 cases) were matched. Cox regression model showed no statistical difference in the long-term survival between CABG alone group and combined procedure group (p = 0.52). Cardiac death (p = 1.00), heart failure (p = 0.68), and cerebrovascular event (p − 0.80) requiring admission were not different between groups as well. The incidence of mitral re-intervention was very few (2 cases in CABG only group, 4 cases in CABG + mitral repair group).

Conclusions

In patients with moderate ischemic MR, additional mitral repair to CABG did not improve long-term survival, freedom from heart failure, or cerebrovascular event.
Appendix
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Literature
1.
Chan KM, Punjabi PP, Flather M, Wage R, Symmonds K, Roussin I, Rahman-Haley S, Pennell DJ, Kilner PJ, Dreyfus GD, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation. 2012;126(21):2502–10.CrossRefPubMed
2.
Smith PK, Puskas JD, Ascheim DD, Voisine P, Gelijns AC, Moskowitz AJ, Hung JW, Parides MK, Ailawadi G, Perrault LP, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2014;371(23):2178–88.CrossRefPubMedPubMedCentral
3.
Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, Acker MA, Hung JW, Chang HL, Perrault LP, et al. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. N Engl J Med. 2016;374(20):1932–41.CrossRefPubMedPubMedCentral
4.
Tsukihara H, Motomura N, Takamoto S. Audit-Based Quality Validation of the Japan Cardiovascular Surgery Database. Circulation J. 2021;85:2014.CrossRef
5.
Koelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J. 2002;144(3):524–9.CrossRefPubMed
6.
Nishino S, Watanabe N, Kimura T, Enriquez-Sarano M, Nakama T, Furugen M, Koiwaya H, Ashikaga K, Kuriyama N, Shibata Y. The Course of Ischemic Mitral Regurgitation in Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention: From Emergency Room to Long-Term Follow-Up. Circ Cardiovasc Imaging. 2016;9(8): e004841.CrossRefPubMed
7.
Dal-Bianco JP, Aikawa E, Bischoff J, Guerrero JL, Hjortnaes J, Beaudoin J, Szymanski C, Bartko PE, Seybolt MM, Handschumacher MD, et al. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve. J Am Coll Cardiol. 2016;67(3):275–87.CrossRefPubMedPubMedCentral
8.
Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, Smith PK, Hung JW, Blackstone EH, Puskas JD, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23–32.CrossRefPubMed
9.
Kuwahara E, Otsuji Y, Iguro Y, Ueno T, Zhu F, Mizukami N, Kubota K, Nakashiki K, Yuasa T, Yu B, et al. Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering. Circulation. 2006;114(1 Suppl):I529-534.PubMed
10.
Messas E, Pouzet B, Touchot B, Guerrero JL, Vlahakes GJ, Desnos M, Menasche P, Hagege A, Levine RA. Efficacy of chordal cutting to relieve chronic persistent ischemic mitral regurgitation. Circulation. 2003;108(Suppl 1):111–5.
11.
Borger MA, Murphy PM, Alam A, Fazel S, Maganti M, Armstrong S, Rao V, David TE. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007;133(6):1483–92.CrossRefPubMed
12.
David TE. Ischemic Mitral Regurgitation: Chordal-Sparing Mitral Valve Replacement. Oper Tech Thorac Cardiovasc Surg. 2012;17(3):194–203.CrossRef
13.
Fattouch K, Lancellotti P, Castrovinci S, Murana G, Sampognaro R, Corrado E, Caruso M, Speziale G, Novo S, Ruvolo G. Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2012;143(6):1352–5.CrossRefPubMed
14.
Cappabianca G, Bichi S, Patrini D, Pellegrino P, Poloni C, Perlasca E, Redaelli M, Esposito G. Cut-and-transfer technique for ischemic mitral regurgitation and severe tethering of mitral leaflets. Annal Thoracic Surg. 2013;96(5):1607–13.CrossRef
15.
Hvass U, Joudinaud T. The papillary muscle sling for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2010;139(2):418–23.CrossRefPubMed
16.
Rabbah JP, Siefert AW, Bolling SF, Yoganathan AP. Mitral valve annuloplasty and anterior leaflet augmentation for functional ischemic mitral regurgitation: quantitative comparison of coaptation and subvalvular tethering. J Thorac Cardiovasc Surg. 2014;148(4):1688–93.CrossRefPubMedPubMedCentral
17.
Gelsomino S, Lorusso R, De Cicco G, Capecchi I, Rostagno C, Caciolli S, Romagnoli S, Da Broi U, Stefano P, Gensini GF. Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation. Eur Heart J. 2008;29(2):231–40.CrossRefPubMed
18.
Komeda M, Koyama Y, Fukaya S, Kitamura H. Papillary heads “optimization” in repairing functional mitral regurgitation. J Thorac Cardiovasc Surg. 2012;144(5):1262–4.CrossRefPubMed
19.
Kongsaerepong V, Shiota M, Gillinov AM, Song JM, Fukuda S, McCarthy PM, Williams T, Savage R, Daimon M, Thomas JD, et al. Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation. Am J Cardiol. 2006;98(4):504–8.CrossRefPubMed
20.
Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Senechal M. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation. 2007;115(6):782–91.CrossRefPubMed
21.
McGee EC, Gillinov AM, Blackstone EH, Rajeswaran J, Cohen G, Najam F, Shiota T, Sabik JF, Lytle BW, McCarthy PM, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128(6):916–24.CrossRefPubMed
22.
Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, et al. JCS/JSCS/JATS/JSVS 2020 Guidelines on the management of valvular heart disease. Circ J. 2020;84(11):2037–119.CrossRefPubMed
23.
Francesco Grigioni M, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic Mitral Regurgitation Long-term outcome and prognostic implications with quantitive doppler assessment. Circulation. 2001;103:1759–64.CrossRef
24.
Committee for Scientific Affairs TJAfTS, Shimizu H, Okada M, Toh Y, Doki Y, Endo S, Fukuda H, Hirata Y, Iwata H, Kobayashi J et al. Thoracic and cardiovascular surgeries in Japan during 2018: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2020.
25.
El-Hag-Aly MA, El Swaf YF, Elkassas MH, Hagag MG, Allam HK. Moderate ischemic mitral incompetence: does it worth more ischemic time? Gen Thorac Cardiovasc Surg. 2020;68(5):492–8.CrossRefPubMed
26.
Grayburn PA, Sannino A, Packer M. Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT Trials. JACC Cardiovasc Imaging. 2019;12(2):353–62.CrossRefPubMed
27.
Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. New England J Med. 2018;379:2307.CrossRef
Metadata
Title
Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate–severe ischemic mitral regurgitation
Authors
Kaoru Matsuura
Hiraku Kumamaru
Goro Matsumiya
Noboru Motomura
Publication date
28-03-2023
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 10/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01925-8

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