Off-Pump Revascularization in Moderate Ischemic Mitral Regurgitation.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Mehmet Sanser Ates, Gulen Sezer Alptekin, Zumrut Tuba Demirozu, Yilmaz Zorman, Atif Akcevin
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引用次数: 0

Abstract

Background:  Ischemic mitral regurgitation (IMR) is associated with high mortality and poor outcomes. The surgical management of moderate IMR is still an object of debate.

Methods:  Patients with moderate IMR who underwent isolated off-pump coronary bypass grafting (OPCAB) with facile stabilization between January 2015 and February 2022 were analyzed. The primary endpoint was the remaining IMR and echocardiographic findings while the secondary outcomes were defined as mortality, major adverse events, and postoperative functional status.

Results:  Of 541 patients who underwent isolated OPCAB in this period, there were 62 patients with concomitant moderate IMR. The mean follow-up period was 19.4 ± 21.6 months. The median number of the coronary anastomosis was 4. In 58.06% (n = 36), the regurgitation regressed. Left atrial (LA) diameter significantly decreased postoperatively (p = 0.040). Increased LA diameter was associated with increased major adverse events (p = 0.010). Rehospitalization rates were higher in low ejection fraction (EF). The postoperative poor functional status (New York Heart Association [NYHA] III-IV) was correlated with an increased postoperative left ventricular end-systolic diameter (LVESD; 41.75 ± 6.13 vs. 34.79 ± 6.8 mm, p = 0.05). Mortality (4.8%, n = 3) was associated with older age and increased preoperative systolic pulmonary artery pressure (PAP; p = 0.050 and p = 0.046, respectively).

Conclusion:  LA diameter, LVESD, mean systolic PAP, left ventricular ejection fraction (LVEF), and age are important predictors for outcomes in IMR. Remaining IMR per se is not directly correlated with increased mortality and major adverse cardiac and cerebrovascular events. The facile stabilization technique we used appears to be advantageous due to the feasibility of full revascularization of all intended vessels, particularly of the inferoposterior wall by providing excellent vision without compression of the heart.

中度缺血性二尖瓣反流的泵外血管重建术
背景:缺血性二尖瓣反流(IMR)与高死亡率和不良预后相关。中度二尖瓣反流的手术治疗仍是争论的焦点:方法:分析了2015年1月至2022年2月期间接受分离式无泵冠状动脉旁路移植术(OPCAB)且术后情况稳定的中度IMR患者。主要终点是剩余的缺血性二尖瓣反流和超声心动图结果,次要结果是死亡率、主要不良事件和术后功能状态:在此期间接受孤立 OPCAB 的 541 名患者中,有 62 名患者同时伴有中度 IMR。平均随访时间为(19.4±21.6)个月。冠状动脉吻合次数的中位数为 4 次(1-6 次)。58.06%(36 人)的反流症状得到缓解。术后左心房(LA)直径明显缩小(p= .040)。LA 直径增大与主要不良事件增加有关(p=.010)。EF值低的患者再住院率更高。术后不良功能状态(NYHA III-IV)与术后左心室收缩末期直径增大相关(41.75±6.13 v.s. 34.79±6.8,P=.05)。死亡率(4.8%,n=3)与年龄较大和术前肺动脉收缩压升高有关(分别为p= .050;p= .046):结论:LA直径、LVESD、平均收缩肺动脉压、LVEF和年龄是IMR预后的重要预测因素。剩余IMR本身与死亡率和MACCE的增加并无直接关联。我们在此采用的简便稳定技术具有优势,因为它可以在不压迫心脏的情况下提供良好的视野,对所有预定血管尤其是后壁血管进行全面再通。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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