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Thorac Cardiovasc Surg
DOI: 10.1055/a-2444-9602
Original Cardiovascular

Off-Pump Revascularization in Moderate Ischemic Mitral Regurgitation

Mehmet Sanser Ates
1   Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
,
Gulen Sezer Alptekin
2   Department of Cardiovascular Surgery, Kutahya University of Health Sciences, Faculty of Medicine, Kutahya, Turkey
,
Zumrut Tuba Demirozu
1   Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
,
Yilmaz Zorman
1   Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
,
Atif Akcevin
1   Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
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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.

Keywords

off-pump surgery - CABG - echocardiography (all modalities - applications)

Ethical Approval Statement

This study was approved by the Local Ethics Committee and informed consent was waived regarding the retrospective nature of the study.




Publication History

Received: 11 June 2024

Accepted: 14 October 2024

Accepted Manuscript online:
17 October 2024

Article published online:
19 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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