TITLE

Mitral regurgitation progression following isolated coronary artery bypass surgery: frequency, risk factors, and potential prevention strategies

AUTHOR(S)
Campwala, Saida Zen; Bansal, Ramesh C.; Wang, Nan; Razzouk, Anees; Pai, Ramdas G.
PUB. DATE
March 2006
SOURCE
European Journal of Cardio-Thoracic Surgery;Mar2006, Vol. 29 Issue 3, p348
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Background: Though de novo mitral regurgitation (MR) is frequently seen in patients who have undergone coronary artery bypass surgery (CABG), its incidence, predictors, and mechanisms are not known. Methods: Our surgical registry was screened for patients undergoing isolated CABG who had preoperative and postoperative resting echocardiograms performed at our institution with ≤2+ MR preoperatively. This yielded 438 patients. Progression to 3–4+ MR post-CABG was correlated with clinical, electrocardiographic, echocardiographic, and operative variables. Results: New 3–4+ MR developed in 11 (10%) of the 108 patients with no prior MR, 21 of the 180 (12%) patients with pre-CABG 1+ MR, and 37 of the 150 (25%) patients with pre-CABG 2+ MR. MR progression correlated with female gender (42% vs 27%, p =0.01), history of renal insufficiency (12% vs 5%, p =0.05), prior-CABG (30% vs 17%, p =0.01), lack of beta-blocker use (19% vs 35%, p =0.008), lower incidence of significant PDA stenosis grafted (88% vs 98%, p =0.003), lower preoperative LVEF (42±19% vs 50±17%, p =0.001), larger LV size (p =0.01), pre-CABG MR grade (p =0.0002), and pre-CABG presence of LBBB block (20% vs 4%, p <0.0001). Independent predictors of MR progression, pre-CABG, were female gender (p =0.002), history of renal insufficiency (p =0.05), lack of beta-blocker use (p =0.006), MR grade (p =0.02), and presence of LBBB (p =0.005). Conclusion: Development of significant MR following isolated CABG is common and may be related to incomplete myocardium revascularization, especially in the PDA area and LV remodeling. Preoperative, beta-blocker use may be protective against its development.
ACCESSION #
19687942

 

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