Contemporary Management of Ischemic Mitral Regurgitation at Coronary Artery Bypass Grafting

Authors

Michael J. Pienta
Patty Theurer
Chang He
Melissa Clark
Jonathan Haft
Steven F. Bolling
Charles Willekes
Hassan Nemeh, Henry Ford HealthFollow
Richard L. Prager
Matthew A. Romano
Gorav Ailawadi

Recommended Citation

Pienta MJ, Theurer P, He C, Clark M, Haft J, Bolling SF, Willekes C, Nemeh H, Prager RL, Romano MA, and Ailawadi G. Contemporary Management of Ischemic Mitral Regurgitation at Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 115(1):88-95.

Document Type

Article

Publication Date

1-1-2023

Publication Title

The Annals of thoracic surgery

Abstract

BACKGROUND: Recent guidelines for the treatment of moderate or severe ischemic mitral regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) have changed. This study assessed the real-world impact of changing guidelines on the management of IMR during CABG over time. We hypothesized that the utilization of mitral valve repair for IMR would decrease over time, whereas mitral valve replacement for severe IMR would increase.

METHODS: Patients undergoing CABG in a statewide collaborative database (2011-2020) were stratified by severity of IMR. Trends in mitral valve repair or replacement were evaluated. To account for differences of the patients, propensity score-matched analyses were used to compare patients with and without mitral intervention.

RESULTS: A total of 11,676 patients met inclusion criteria, including 1355 (11.6%) with moderate IMR and 390 (3.3%) with severe IMR. The proportion of patients undergoing mitral intervention for moderate IMR decreased over time (2011, 17.7%; 2020, 7.5%; P(trend) = .001), whereas mitral replacement for severe IMR remained stable (2011, 11.1%; 2020, 13.3%; P(trend) = .14). Major morbidity was higher for patients with moderate IMR who underwent mitral intervention (29.1% vs 19.9%; P = .005). In a propensity analysis of 249 well-matched pairs, there was no difference in major morbidity (29.3% with mitral intervention vs 23.7% without; P = .16) or operative mortality (1.2% vs 2.4%; P = .5).

CONCLUSIONS: Consistent with recent guideline updates, patients with moderate IMR were less likely to undergo mitral repair. However, the rate of replacement for severe IMR did not change. Mitral intervention during CABG did not increase operative mortality or morbidity.

Medical Subject Headings

Humans; Mitral Valve Insufficiency; Treatment Outcome; Coronary Artery Bypass; Heart Valve Prosthesis Implantation; Myocardial Ischemia

PubMed ID

36150477

Volume

115

Issue

1

First Page

88

Last Page

95