Coronary artery revascularization combined with server ischemic mitral valve repair early and midterm outcome
DOI:
https://doi.org/10.61841/dyh69g28Keywords:
mitral regurgitation, peripheral vascular disease, coronary angiography, Carotid Doppler study, coronary artery revascularizationAbstract
Functional ischemic mitral regurgitation (MR) occur in up to 40% of patients after myocardial infraction. Chronic ischemic mitral regurgitation (IMR) is a frequent and important complication after myocardial infarction. This is a single center, retrospective, single cohort study, during two year period (2018–2020). It included all the cases of combined operation of MV repair and CABG. Follow-up of patients was performed through clinical visit.The patients were followed up for a median duration of (six months to 1 year).All patients underwent transthoracic echocardiography (TTE) and preoperative coronary angiography. Carotid Doppler study was requested for those patients with previous stroke and/or peripheral vascular disease (PVD).The followings were obtained; socio-demographic data, information regarding clinical courses, intraoperative findings, and post-operative follow up data.The study included 68 cases, the mean age was 58 years (ranging from 45 to 78 years), 36 (52.9%) were males and 32(47%) were female. The most common comorbidity was hypertension which was found in 22(32.3%) patients. The mean preoperative ejection fraction was 54%. Twenty-two patients had single graft, 29 patients underwent 3-vessel grafting, 17 patients had 2- vessel grafting.The CPB duration ranged from 120 to 140 min with a mean of 120 min and cross-clamp time ranged from 40 to 80 min. The average duration of admission to the intensive care unit was ranging from 48 h to 72 h. The patients stayed at hospital a mean of 8 days (ranging from 7 to 10 days). The most common complication was Arrhythmia which occurred in 8 cases and managed (Table 2). Overall mortality was 4.4% (3 patients), the causes were as the followings; CVA in one case, multi-organ failure in one case and cardiac tamponade in one case who was presented two weeks after operation. In conclusion, early mortality was less, quality of life better, but no reduction in late mortality.
Downloads
References
1. Aronson D, Goldsher N, Zukermann R, Kapeliovich M. Ischemic MR and risk of heart failure
after myocardial infarction. Arch Intern Med. 2006; 166:2362–2368
2. Piérard LA, Carabello BA. Ischaemic mitral regurgitation: pathophysiology, outcomes and the
conundrum of treatment. Eur Heart J. 2010;31:2996–3005
3. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al.
Guidelines on the management of valvular heart disease (version 2012).Eur Heart J.
2012;33:2451–96.
4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin 3rd JP, Guyton RA, et al. 2014
AHA/ACC guideline for the management of patients with valvular heart disease: a report of the
American College of Cardiology/ American Heart Association Task Force on Practice
Guidelines. J Am CollCardiol. 2014;63:e57– e185
5. Vahanian A, Alfieri O, Andreotti F, et al. The Joint Task Force on the Management of Valvular
Heart Disease of the European Society of Cardiology and the European Association for
CardioThoracic Surgery. Guidelines on the management of valvular heart disease (version
2012). Eur Heart J. 2012;33:2451– 96.
6. Fattouch et al, Efficacy of adding mitral valve restrictive annuloplasty to coronary artery
bypass grafting in patients with moderate ischemic mitral valve regurgitation: A randomized
trial, The Journal of Thoracic and Cardiovascular Surgery c August 2009.
7. Karimi A et al. EARLY OUTCOME OF CONCURRENT MITRAL VALVE
REPLACEMENT AND CORONARY ARTERY BYPASS GRAFTING, ActaMedicaIranica,
46(3): 213-217; 2008.
8. Adult cardiac surgery database. Society of Thoracic Surgeons, Chicago. 2012.
http://www.sts.org/national-database. Accessed 17 Dec 2015
9. M.P.B.O. Sá et al, Mitral valve replacement combined with coronary artery bypass graft
surgery in patients. Portuguese journal of cardiology,2013:32(2)131- 137
10. Wang et al, Repair or replace ischemic mitral regurgitation during coronary artery bypass
grafting? A meta-analysis, Journal of Cardiothoracic Surgery (2016) 11:141 DOI
10.1186/s13019-016-0536-6
11. Despotis GJ, Filos KS, Zoys TN, Hogue CW Jr, Spitznagel E, Lappas DG. Factors associated
with excessive postoperative blood loss and hemostatic transfusionrequirements: a multivariate
analysis in cardiac surgical patients. AnesthAnalg. 1996;82:13-21.
12. Sablotzki A, Welters I, Lehmann N, Menges T, Gorlach G, Dehne M, et al. Plasma levels of immunoinhibitory cytokines interleukin-10 and transforming growth factor-b in patients
undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg. 1997;11:763-8.
13. Taylor KM. Brain damage during cardiopulmonary bypass. Ann Thorac Surg. 1998;65:S20-6.
14. Acker MA, Parides MK, Perrault LP, et al. Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. N Engl J Med.2014; 370:23–32
15. Ahmed, O.F., Kakamad, F.H., Almudhaffar, S.S., Hachim, R.H., Najar, K.A., Salih, A.M., Hussen, D.A., Mohammed, S.H., Mustafa, M.Q., Mohammed, K.K. and Omar, D.A., 2021. Combined operation for coronary artery bypass grafting and mitral valve replacement; risk and outcome. International Journal of Surgery Open, 35, p.100393.
Downloads
Published
Issue
Section
License
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
