Predictive Risk Factors for Early Mortality in Operative Treatment for Chronic Ischemic Mitral Insufficiency
DOI:
https://doi.org/10.1532/HSF98.20061172Abstract
Background. The combination of coronary artery bypass grafting and mitral valve surgeries is closely associated with high in-hospital mortality and morbidity. In this study, we sought to analyze the factors that influence early mortality in 68 patients undergoing coronary artery bypass grafting + mitral valve surgery due to ischemic mitral insufficiency.
Methods. Of 1183 patients undergoing coronary bypass surgery between April 2002 and June 2006, 68 patients (42 male and 26 female) 42 to 78 years of age (mean ± SD, 59.3 ± 9.1) underwent mitral valve surgery accompanying coronary bypass surgery (survival, n = 59; mortality, n = 9). The cases were analyzed regarding the demographic, preoperative, and perioperative risk factors that influence mortality.
Results. The early mortality rate was found to be 13.2% (9/68) in patients with ischemic mitral regurgitation undergoing simultaneous coronary bypass and mitral valve surgeries. New York Heart Association class ?3, left ventricle end-systolic volume, left ventricle end-systolic diameter, cardiopulmonary perfusion time, preoperative unstable angina pectoris, intra-aortic balloon application, and age >65 years were determined to be statistically significant risk factors that influence early in-hospital mortality.
Conclusion. Surgery, despite having a high mortality risk in patients with ischemic mitral insufficiency, is considered to be a treatment measure that generally improves the quality of life and prolongs life.
References
Andrade IG, Cartier R, Panisi P, Ennabli K, Grondin CM. 1987. Factors influencing early and late survival in patients with combined mitral valve replacement and myocardial revascularization and in those with isolated replacement. Ann Thorac Surg 44:607-13.nCzer LS, Gray RJ, DeRobertis MA, et al. 1984. Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation 70:198-207.nEreminiene E, Vaskelyte J, Benetis R, Stoskute N. 2005. Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling. Echocardiography 22:217-24.nGeidel S, Lass M, Schneider C, et al. 2005. Downsizing of mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling. Eur J Cardiothorac Surg 27:1011-6.nGrigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. 2001. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103:1759-64.nHarris KM, Sundt TM, Aeppli D, Sharma R, Barzilai E. 2002. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg 74:1468-75.nJouan J, Tapia M, Cook RC, Lansac E, Acar C. 2004. Ischemic mitral valve prolapse: mechanisms and implication for valve repair. Eur J Cardiothorac Surg 26:1112-7.nNicolini F, Zoffoli G, Cagnoni G, et al. 2006. Mitral valve annuloplasty and myocardial revascularization in the treatment of ischemic dilated cardiomyopathy. Heart Vessels 21:28-32.nPrifti E, Bonacchi M, Frati G, Giunti G, Batabasi G, Sani G. 2001. Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization. J Heart Valve Dis 10:754-62.nSeipelt RG, Schoendube FA, Vazquez-Jimenez JF, Doerge H, Voss M, Messmer BJ. 2001. Combined mitral valve and coronary artery surgery: ischemic versus non-ischemic mitral valve disease. Eur J Cardiothorac Surg 20:270-5.nSzalay ZA, Civelek A, Hohe S, et al. 2003. Mitral annuloplasty in patients with ischemic versus dilated cardiomyopathy. Eur J Cardiothorac Surg 23:567-72.nUchikawa S, Eiji Ohtaki E, Sumiyoshi T, Hosoda S, Kasegawa H. 2004. Impact of mitral regurgitation on long term survival in patients with ischemic cardiomyopathy: efficacy of combined mitral valve repair and revascularization. Heart Vessels 19:172-8.n