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Isolated OPCABG in moderate chronic ischemic mitral regurgitation: is it a justifiable alternative approach ?

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Abstract

Objective

Current evidence does not allow a consensus on the management of moderate chronic ischemic mitral regurgitation (CIMR). We compared moderate CIMR patients undergoing off-pump CABG (OPCABG) alone and CABG + MV repair for early mortality, major adverse systemic events (MASE) and mid-term functional outcomes.

Methods

210 patients with moderate CIMR who underwent off-pump coronary artery bypass grafting (OPCABG) Group I (n = 106) or CABG + mitral valve repair (MV rep) Group II (n = 104) were followed prospectively. For comparison, patients were further sub-divided based on the product of regurgitant fraction and ejection fraction "RFEF"(Good/Bad) and MR jet direction (Central/Eccentric). The primary end point of the study was mortality and secondary end points were MASE, percentage improvements in indexed left ventricle end-systolic volume (LVESVI %), MR grade and functional outcomes of the patients.

Results

In-hospital and overall mortality was significantly lower in Group I (1.89% vs. 13.46%, p < 0.001 and 5.66% vs. 15.38%; p = 0.024 respectively). Group II had significantly higher MASE, ventilation time, mean ICU and hospital stay. At 36 months, LVESVI% (17.56% ± 9.12% vs. 18.81% ± 7.48%; p = 0.279), MR grade improvement (80.18% vs. 83.50%; p = 0.544), NYHA class and MLHF scores were also similar in both groups. On subgroup analysis, Good RFEF with Central jet subgroup had comparable improvement in LVESVI% and MR grade with either procedure, while Bad Eccentric subgroup showed a significantly higher improvement in LVESVI% and MR grade with CABG + MV repair.

Conclusion

OPCABG is associated with significantly reduced mortality and MASE with comparable improvement in LVEDVI% and MR grade. CABG + MV Rep results in significant improvement in LVEDVI% and MR grade in patients with bad eccentric MR. The recommended procedures in the "Good Central" and "Bad Eccentric" subsets are CABG and CABG + Mvrepair, respectively.

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Author information

Authors and Affiliations

  1. Department of cardiothoracic Surgery, Baylor Scott and White Health, Temple, TX, 76508, USA

    Amber Malhotra

  2. Départment of Cardiothoracic and Vascular Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA

    Pankaj Garg

  3. Department of cardiothoracic surgery, Datta Maghe Institute of Medical Sciences Sawangi (Meghe), Wardha, 442004, Maharashtra, India

    Sumbul Siddiqui

  4. Indian Institute of Public health Gandhinagar, Gandhinagar, 382042, Gujarat, India

    Komal Shah

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  1. Amber Malhotra
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Correspondence to Pankaj Garg.

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There was no conflict of interest of any author; none of the authors received any grants.

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The study did not involve the use of any animal. In case of patients, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent has been taken from patients and none have been forced to be a part of the study.

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Malhotra, A., Garg, P., Siddiqui, S. et al. Isolated OPCABG in moderate chronic ischemic mitral regurgitation: is it a justifiable alternative approach ?. Gen Thorac Cardiovasc Surg 70, 850–861 (2022). https://doi.org/10.1007/s11748-022-01822-6

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  • DOI: https://doi.org/10.1007/s11748-022-01822-6

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