| Background:Ischemic mitral insufficiency is a common consequence after myocardial infarction or left ventricular dysfunction in patients with coronary heart disease.Surgical coronary revascularization is the recommended to improve the clinical prognosis for patients.For moderate ischemic mitral regurgitation,whether to combine surgical mitral intervention in the mean time is still a controversial issue.Methods:In order to determine the impact of mitral valve surgery during CABG on the long-term prognosis of such patients,we enrolled patients diagnosed with moderate ischemic mitral regurgitation and underwent CABG in our center from January 2013 to December 2018.They were divided into two groups according to whether underwent combined mitral valve surgical intervention,and followed up for long-term cardiac events(including cardiac death,MI,revascularization,CHF,mitral valve reoperation,new onset of atrial fibrillation,and worsening NYHA class),all-cause death and MACCE events(including rehospitalization for heart failure,cardiogenic death,cerebrovascular accident,MI and revascularization).Cardiac events were the primary endpoint,while all-cause death and MACCE events were secondary endpoints.Propensity matching cohorts was established for analysis.Results:108 patients with isolated CABG and 126 patients with combined mitral surgery were enrolled and the matched cohort included 78 pairs of patients.After an average follow-up of 59 months,nine patients(8.6%)in CABG group and twelve patients(9.9%)in CABG+MVS died.Patients in both groups had left ventricular reverse remodeling in the early stage after operation.Patients in CABG+MVS group had higher cardiopulmonary bypass time,ICU time and hospitalization cost,while the proportion of residual mitral regurgitation was lower.Survival analysis showed that the long-term incidence of cardiac events in patients undergoing surgical mitral valve surgery at the same time was significantly higher(original cohort 32.2%vs.20.0%P=0.03;matching cohort 38.5%vs.23.1%P=0.04),the difference was mainly due to the higher incidence of postoperative new onset of atrial fibrillation in this group(original cohort 19.0%vs.2.9%P<0.01;matching cohort 24.4%vs.2.6%P<0.01);while there was no significant difference in the all-cause death,cardiogenic mortality and MACCE events between two groups.Cox regression analysis indicated combined mitral procedure was a risk factor for long-term cardiac events and new onset of atrial fibrillation.The subgroup study found that patients with preoperative left ventricular end diastolic diameter>55mm,EF≤ 55%had a higher probability of cardiac events underwent combined-procedure;and patients with preoperative left ventricular end diastolic diameter>55mm,EF<55%and left atrial diameter>40mm had a higher probability of atrial fibrillation underwent combined-procedure.Conclusion:Our study found that for patients with moderate ischemic mitral regurgitation,the long-term survival rates of the two groups were similar at the time of coronary artery bypass grafting.Surgical intervention of mitral valve in the same period can maintain low residual regurgitation,but the incidence of long-term cardiac events and arrhythmias is high.Background:Ischemic mitral regurgitation is a common complication of coronary artery disease.Previous studies on the surgical treatment of moderate ischemic mitral regurgitation are controversial.To find the prognostic factors and the best surgical strategy in patients with moderate ischemic mitral regurgitation is the focus of current research.Previous studies have found that functional tricuspid regurgitation often appear and progress when ischemic mitral regurgitation exist and indicates a bad outcome.However,there is no study on the prognosis of different surgical strategies in patients with ischemic mitral regurgitation combined with mild above tricuspid regurgitation.Therefore,the purpose of this study is to determine the long-term prognosis of such patients after different operation,so as to find the best surgical strategy.Methods:We continuously enrolled patients with moderate ischemic mitral regurgitation combined with mild above functional tricuspid regurgitation who underwent coronary artery bypass in our center from January 2013 to December 2018.They were divided into two groups:isolated coronary artery bypass grafting and simultaneous mitral valve surgery during coronary artery bypass grafting.Through long-term follow-up,the differences of long-term all-cause death and incidence of MACCE events between the two groups were analyzed,and the differences of perioperative echocardiographic changes and adverse events were analyzed.Multivariate Cox regression analysis was used to find the risk factors of long-term all-cause death and MACCE events in patients with moderate ischemic mitral regurgitation combined with mild above functional tricuspid regurgitation after coronary artery bypass grafting.Results:A total of 71 patients were included in the study.Through the long-term follow-up with an average time of 56 months,it was found that there were significant differences in the long-term all-cause death and the incidence of long-term MACCE events between the two groups.The long-term all-cause death(2.86%vs.22.86%P=0.028)and the incidence of long-term MCCE events(22.22%vs.45.71%P=0.011)was lower in the mitral valve surgery group.Multivariate regression analysis showed that simultaneous mitral valve surgery was a protective factor for long-term all-cause death of such patients(aHR=0.03,95%CI 0.00-0.40 P=0.009),while larger left atrium and higher preoperative creatinine level were risk factors.For the long-term incidence of MACCE events,mitral valve surgery at the same time is also a protective factor(aHR=0.29,95%CI 0.09-0.95 P=0.04),while older age and higher preoperative creatinine level are the risk factors.Conclusion:We found that for patients with moderate ischemic mitral regurgitation with mild above functional tricuspid regurgitation,mitral valve surgery at the same time of coronary revascularization can significantly reduce the long-term all-cause death and the incidence of MACCE events.Therefore,mild above functional tricuspid regurgitation can be used as an effective clinical index for more radical surgical mitral intervention in such patients. |
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