Predictive Risk Factors for Early Mortality in Operative Treatment for Chronic Ischemic Mitral Insufficiency
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.
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
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).