The The Impact of Surgical Revascularization on Cardiac Function and Mitral Regurgitation in Patients with Coronary Artery Disease: An Intermediate-Term Single-Center Experience

Authors

  • Hani N Mufti, MD, MHI, SLP, CIP, FRCSC Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Mouaz Bamsallm King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Abdulaziz Almalki King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Ammar Aljefri King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Waleed Alnejadi King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Akram Neyaz Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Saad Al Bugami Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
  • Jamilah Al Rahimi Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

DOI:

https://doi.org/10.1532/hsf.5043

Keywords:

Ischemic Heart Disease, Ischemic Mitral Regurgitation, Coronary Arteries Bypass Graft Surgery, Ejection Fraction, Complete revascularization

Abstract

Introduction: Ischemic heart disease is the most common cause of death worldwide. Coronary artery bypass grafting (CABG) is the most performed cardiac surgical procedure. Studies have shown that CABG can have a beneficial effect on left ventricular ejection fraction (LVEF) and ischemic mitral regurgitation (IMR) without intervention on the mitral valve. This study aims to assess changes in LVEF and IMR after CABG in our population.

Methods: We retrospectively reviewed charts of patients who underwent only CABG at King Faisal Cardiac Center in Jeddah between January 2016 and December 2019 (N = 298). Pre- and postoperative echocardiography data were evaluated. Changes in cardiac function and mitral regurgitation were analyzed.

Results: CABG was performed on 298 patients. The median age was 61 years (interquartile range (IQR)= 54–68), and 78.5% of the patients were male. The median body mass index was slightly higher in females (32.9 vs. 28.6 kg/m2, P = 0.089). Approximately 81% of patients had diabetes and hypertension, but only 24% were active smokers. The median time between pre- and postoperative echocardiography was 8 months (IQR= 3–17). The median preoperative LVEF was 51% (IQR= 44.1–57.9), and 75% of patients had normal-to-mild MR. The median postoperative EF was not different among patients who underwent echocardiography within or after 6 months (53.1% and 50.3%, respectively, P = 0.454). None of the patients progressed to severe MR after surgery, and only 2.7% had moderate-to-severe MR at follow up. Postoperative in-hospital mortality was 0.7%.

Conclusion: Based on international guidelines and the best evidence, surgical revascularization is sufficient for patients with coronary artery disease (CAD) with moderate IMR and is not associated with LVEF worsening or MR progression. Complete revascularization might have an influence on ventricular recovery that might improve or stabilize IMR. Our results are consistent with larger studies reporting very low postoperative mortality of this high-risk patient group.

References

Bianco V, Kilic A, Aranda-Michel E, Serna-Gallegos D, Ferdinand F, Dunn-Lewis C, et al. 2021. Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events. J Thorac Cardiovasc Surg.

Cui K, Zhang D, Lyu S, Song X, Yuan F, Xu F, et al. 2018. Meta-Analysis Comparing Percutaneous Coronary Revascularization Using Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients With Left Ventricular Systolic Dysfunction. Am J Cardiol. 122(10):1670-6.

Fanari Z, S AW, Weintraub WS. 2013. Comparative effectiveness of revascularization strategies in stable ischemic heart disease: current perspective and literature review. Expert Rev Cardiovasc Ther. 11(10):1321-36.

Felker GM, Shaw LK, O'Connor CM. 2002. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 39(2):210-8.

Fryar CD, Chen TC, Li X. 2012. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999-2010. NCHS Data Brief. (103):1-8.

Gössl M, Faxon DP, Bell MR, Holmes DR, Gersh BJ. 2012. Complete versus incomplete revascularization with coronary artery bypass graft or percutaneous intervention in stable coronary artery disease. Circ Cardiovasc Interv. 5(4):597-604.

Haxhibeqiri-Karabdic I, Hasanovic A, Kabil E, Straus S. 2014. Improvement of ejection fraction after coronary artery bypass grafting surgery in patients with impaired left ventricular function. Med Arch. 68(5):332-4.

Jonkers D, Elenbaas T, Terporten P, Nieman F, Stobberingh E. 2003. Prevalence of 90-days postoperative wound infections after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 23(1):97-102.

Kochanek KD, Murphy SL, Xu J, Arias E. 2019. Deaths: Final Data for 2017. Natl Vital Stat Rep. 68(9):1-77.

Koene RJ, Kealhofer JV, Adabag S, Vakil K, Florea VG. 2017. Effect of coronary artery bypass graft surgery on left ventricular systolic function. J Thorac Dis. 9(2):262-70.

Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. 2016. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. N Engl J Med. 374(20):1932-41.

Mufti HN, Jarad M, Haider MM, Azzhary L, Namnqani S, Husain I, et al. 2020. Impact of Pre-operative Hemoglobin A1C Level and Microbiological Pattern on Surgical Site Infection After Cardiac Surgery. Cureus. 12(12):e11851.

Ngu JMC, Ruel M, Sun LY. 2018. Left ventricular function recovery after revascularization: comparative effects of percutaneous coronary intervention and coronary artery bypass grafting. Curr Opin Cardiol. 33(6):633-7.

Salmasi MY, Harky A, Chowdhury MF, Abdelnour A, Benjafield A, Suker F, et al. 2018. Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery? J Card Surg. 33(7):374-84.

Savarese G, Lund LH. 2017. Global Public Health Burden of Heart Failure. Card Fail Rev. 3(1):7-11.

Virk SA, Tian DH, Sriravindrarajah A, Dunn D, Wolfenden HD, Suri RM, et al. 2017. Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: Meta-analysis of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg. 154(1):127-36.

Wang Q, Primiano C, Sun W. 2014. Can isolated annular dilatation cause significant ischemic mitral regurgitation? Another look at the causative mechanisms. J Biomech. 47(8):1792-9.

Wood PW, Choy JB, Nanda NC, Becher H. 2014. Left ventricular ejection fraction and volumes: it depends on the imaging method. Echocardiography. 31(1):87-100.

Zhang Y, Ma L, Zhao H. 2015. Efficacy of mitral valve repair as an adjunct procedure to coronary artery bypass grafting in moderate ischemic mitral regurgitation: a meta-analysis of randomized trials. J Card Surg. 30(8):623-30.

Published

2022-12-30

How to Cite

Mufti, H., Bamsallm, M. ., Almalki, A., Aljefri, A., Alnejadi, W., Neyaz, A., Al Bugami, S., & Al Rahimi, J. (2022). The The Impact of Surgical Revascularization on Cardiac Function and Mitral Regurgitation in Patients with Coronary Artery Disease: An Intermediate-Term Single-Center Experience. The Heart Surgery Forum, 25(6), E863-E870. https://doi.org/10.1532/hsf.5043

Issue

Section

Article