Early And Intermediate Prognosis Study Of The Simultaneous Mitral Valve Surgery In Patients With Coronary Heart Disease And Moderate Mitral Regurgitation

Research background:Ischemic mitral regurgitation(IMR),also known as secondary mitral regurgitation,is a common mitral valve dysfunction disorder.Coronary artery bypass graft(CABG)is the main and most effective treatment strategy for patients with coronary heart disease and can alleviate IMR.Unfortunately,however,there is still controversy about whether mitral valve lesions are managed concomitantly with CABG in patients with coronary artery disease(CAD)and moderate IMR in clinical practice.There is a lack of evidencebased medical evidence on whether prophylactic mitral valve surgery is beneficial.Research aim:This review retrospectively analyzed the data of CABG alone versus combined mitral valve surgery in patients with CAD and moderate IMR in single-center.To assess the surgical risks and early and intermediate prognosis of isolated CABG versus mitral valve surgery,with the aim of exploring the best treatment options for these patients.Research Methods:A retrospective analysis was performed for patients with CAD and moderate IMR in the department of cardiac surgery of Qilu Hospital of Shandong University from January 1,2019 to May 31,2022.Based on coronary angiography,CAD is indicated for CABG surgery.Based on echocardiographic findings,patients with mild and severe mitral regurgitation,organic mitral valve lesions were excluded,and only patients with moderate IMR were excluded.The patients included in the study were divided into two groups,A and B.Group A was CABG alone(n=77),group B was CABG underwent mitral valve plasty/replacement(MVP/MVR)(n=66).Then,all variables such as preoperative baseline information,coronary angiography results,echocardiography parameters,intraoperative and postoperative information,and follow-up information were statistically analyzed between groups to study the early and intermediate prognosis and influencing factors.The statistical methods mainly include:χ2 test is used for intergroup counting data analysis,independent sample t-test is used for measurement data,and regression analysis is used to screen for independent influencing factors of postoperative endpoint events.Research results:A total of 143 cases were finally collected according to the inclusion and exclusion criteria,77(51.8%)cases in group A,with a mean age of 65.77±7.471 years,including 48(62.3%)males and 29(37.7%)females.There were 66(48.2%)cases in group B,with an average age of 62.55±7.473 years,including 34(51.5%)males and 32(48.5%)females.Preoperative data:the general situation showed that the differences between the two groups A and B were not statistically significant and comparable in terms of sex(P=0.080),weight(P=0.440),height(P=0.117),BMI(P=0.939),smoking history(P=0.263),drinking history(P=0.289)and hypertension history(P=0.578).Echocardiographic data showed that the differences between left ventricular size(P=0.778),relationship between E peak and A peak(P=0.058),movement velocity at mitral septal annulus(e’1(cm/s))(P=0.216),lateral wall annulus(e’2(cm/s))(P=0.256),E peak/e’(P=0.372)and other differences were not statistically significant and comparable.Coronary angiography data showed that there was no significant difference in coronary scores between A and B groups(P=0.555),which was comparable.Moreover,the degree of coronary stenosis in both groups was severe stenosis,which meets CABG indications.The preoperative baseline data of groups A and B were basically similar,and there was no statistical difference(P>0.05),and the data were comparable.Intraoperative data:the number of grafting vessels(P=0.001),the number of coronary bypass sequential anastomosis(P=0.004),the flow of left circumflex artery(P=0.037),the operation time(P=0.000),the aortic occlusion time(P=0.018),and the extracorporeal bypass time(P=0.001)were statistically significant.Postoperative data:the number of early death(5 cases in group A,6.49%;6 cases in group B,9.1%;P=0.961),left ventricular ejection fraction(LVEF)(P=0.000),E peak and A peak(P=0.003)were statistically significant.There were no statistical differences in left ventricular size(P=0.057)and left atrial size(P=0.06).Follow-up data:the patients were followed up in the early and middle stages,the longest follow-up time was 50 months,the shortest follow-up time was 0.5 months,the average follow-up time was 24.05± 1.11 months,the median follow-up time was 21 months,11 cases died in early postoperative period(5 cases in group A,6 cases in group B),7 cases died during the interim follow-up period(3 cases in group A,4 cases in group B),although group B(9.1%)was higher than that in group A(6.49%),but the difference was not statistically significant(P=0.961).Although the overall mortality rate B(15.15%)at follow-up was higher than that in group A(10.39%),the difference was not statistically significant(P=0.392).Survival analysis:according to the factors affecting prognosis screened out by univariate Cox regression analysis,the preoperative LVEF(P=0.018),left anterior descending branch stenosis(P=0.026),the flow of left circumflex artery(LCX)flow(P=0.002)were finally included in multivariate Cox regression analysis,prompting:(1)preoperative LVEF(P=0.030,HR=0.057,95%CI:0.0040.757)can be used as an independent protective factor for endpoint events,and if preoperative LVEF is low,patients have a high rate of postoperative intermediate endpoint events.(2)the flow of LCX(P=0.047,HR=0.962,95%CI:0.925-1.000)can be used as an independent protective factor for endpoint events,and if the flow of intraoperative LCX is low,the postoperative intermediate endpoint event rate is high.ROC analysis:The area under the ROC curve of preoperative LVEF was 0.674(95%CI:0.57-0.779,P=0.005).The area under the ROC curve for the flow of LCX was 0.748(95%CI:0.646-0.849,P=0.000).which had good diagnostic performance and high application value.It shows that the two factors have good diagnostic performance and have high application value.Conclusions:through the early and intermediate prognosis study of the simultaneous mitral valve surgery in patients with CAD and moderate IMR,we believe that:(1)The efficacy of CABG alone is reliable.Mortality was lower with CABG alone,regardless of early or mid-operative follow-up.The CABG alone group had a good prognosis at mid-term follow-up,and the mitral valve intervention at the same time did not benefit the patients.(2)CABG alone and CABG+MVP/MVR can improve patients’cardiac function indexes.(3)Preoperative LVEF and low of LCX f can be used as independent protective factors for the occurrence of endpoint events,which has high application value.Preoperative LVEF has a cut-off value of 0.44,and the higher the cut-off value,the lower the postoperative intermediate endpoint event rate;and the lower the specific cut-off value,the higher the postoperative intermediate endpoint event rate.The intraoperative LCX flow rate was 33.5ml/min as the critical value,and the higher the cut-off value,the lower the postoperative intermediate endpoint event rate;the lower the specific cut-off value,and the higher the postoperative intermediate endpoint event rate.