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Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate–severe ischemic mitral regurgitation

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Abstract

Background

Operative indication of the additional mitral repair for moderate ischemic mitral regurgitation (MR) in the setting of coronary artery bypass grafting (CABG) is still unclear.

Methods

This study was designed as the nation-wide multi-center retrospective analysis with additional survival data. CABGs without past heart surgery registered in 2014 and 2015 were included. Concomitant surgery other than tricuspid or arrhythmia surgery, mitral replacement, and off-pump cases, was excluded. Grade 1 or 4 MR, and ejection fraction < 20 or > 50 were excluded. Additional questionnaire was sent to each hospital, regarding the pathology of MR and clinical outcomes. Additional data were registered between May 28, 2021 and Dec 31, 2021, and the primary outcomes were all-death and cardiac death. The secondary outcomes were heart failure and cerebrovascular event requiring admission, mitral re-intervention. Patients underwent on-pump CABG (CABG only group 221 cases) and CABG with mitral repair (CABG + Mitral repair group 276 cases) were enrolled.

Results

After Propensity score matching, 362 cases (CABG only 181cases vs CABG + mitral repair 181 cases) were matched. Cox regression model showed no statistical difference in the long-term survival between CABG alone group and combined procedure group (p = 0.52). Cardiac death (p = 1.00), heart failure (p = 0.68), and cerebrovascular event (p − 0.80) requiring admission were not different between groups as well. The incidence of mitral re-intervention was very few (2 cases in CABG only group, 4 cases in CABG + mitral repair group).

Conclusions

In patients with moderate ischemic MR, additional mitral repair to CABG did not improve long-term survival, freedom from heart failure, or cerebrovascular event.

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Data availability

The data that support the findings of this study are available from NCD database, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available upon reasonable request and with permission of NCD database.

Abbreviations

MR:

Mitral regurgitation

CABG:

Coronary artery bypass grafting

EF:

Ejection fraction

JCVSD:

Japan Cardiovascular Surgery Database

LVAD:

Left ventricular assist device

NYHA:

New York Heart Association

SD:

Standard deviation

IQR:

Inter-quartile range

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Acknowledgements

The authors would like to express their appreciation to the institutions which co-operated with our study especially answering the additional questionnaires.

Funding

This study was supported by the 2nd Japanese Association of Thoracic Surgery (JATS) award for transitional clinical research in 2019.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan

    Kaoru Matsuura & Goro Matsumiya

  2. Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Bunkyo-ku, Hongo 7-3-1, Tokyo, 113-0033, Japan

    Hiraku Kumamaru

  3. Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, Shimoshizu, 564-1, Chiba, 285-0841, Japan

    Noboru Motomura

Authors
  1. Kaoru Matsuura
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Corresponding author

Correspondence to Kaoru Matsuura.

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Conflict of interest

KM and GM report the affiliated department that received the scholarship funds from the Otsuka Pharmaceutical. Co., Ltd, Century Medical Inc., Medtronic Japan Co., Ltd, Terumo Corp, Japan lifeline Co., Ltd. KM is a clinical proctor for Edwards Lifesciences. HK reports receiving consultation fees from Mitsubishi-Tanabe Pharma Corporation, and EPS Corporation, and speaker fees from Chugai Pharmaceutical Co., Ltd. And Johnson and Johnson. KK. HK is affiliated with the Department of Health Quality Assessment at the University of Tokyo, a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl.

Ethical approval

The present study was approved by the institutional review board of Chiba University Graduate School of Medicine Ethical Committee. Reference number: 3688.

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Matsuura, K., Kumamaru, H., Matsumiya, G. et al. Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate–severe ischemic mitral regurgitation. Gen Thorac Cardiovasc Surg 71, 543–551 (2023). https://doi.org/10.1007/s11748-023-01925-8

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