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

Campwala, Saida Zen; Bansal, Ramesh C.; Wang, Nan; Razzouk, Anees; Pai, Ramdas G.
March 2006
European Journal of Cardio-Thoracic Surgery;Mar2006, Vol. 29 Issue 3, p348
Academic Journal
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.


Related Articles

  • Coronary Artery Bypass Grafting Alone. Ogus, Noyan Temucin; Us, Melih Hulusi; Ogus, Halide; Isik, Omer // Texas Heart Institute Journal;2004, Vol. 31 Issue 2, p143 

    In 31 consecutive patients with ischemic left ventricular dysfunction and mitral regurgitation ranging from 2/4 to 3/4 (mean, 2.87 ± 0.34), we performed coronary bypass grafting alone and assessed early and midterm outcomes. Our patients' mean preoperative New York Heart Association...

  • Coronary Revascularization Alone or with Mitral Valve Repair. Goland, Sorel; Czer, Lawrence S. C.; Siegel, Robert J.; DeRobertis, Michele A.; Mirocha, James; Zivari, Kaveh; Kass, Robert M.; Raissi, Sharo; Fontana, Gregory; Cheng, Wen; Trento, Alfredo // Texas Heart Institute Journal;2009, Vol. 36 Issue 5, p416 

    We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr). A total of 83 patients had a reduced left ventricular...

  • Mitral valve surgery simultaneous to coronary revascularization in patients with end-stage ischemic cardiomyopathy. Bonacchi, Massimo; Prifti, Edvin; Maiani, Massimo; Frati, Giacomo; Nathan, Nadia S.; Leacche, Marzia // Heart & Vessels;Jan2006, Vol. 21 Issue 1, p20 

    Mitral valve regurgitation (MVR), occurring as a result of myocardial ischemia and global left ventricular (LV) dysfunction, predicts a poor outcome in terms of survival and morbidity. Between 1995 and 2003, 180 consecutive patients with impaired LV function and chronic ischemic MVR underwent...

  • Mitral valve annuloplasty and myocardial revascularization in the treatment of ischemic dilated cardiomyopathy. Nicolini, Francesco; Zoffoli, Giampaolo; Cagnoni, Giovanni; Agostinelli, Andrea; Colli, Andrea; Fragnito, Claudio; Borrello, Bruno; Beghi, Cesare; Gherli, Tiziano // Heart & Vessels;Jan2006, Vol. 21 Issue 1, p28 

    The aim of this study was to examine perioperative mortality and morbidity and midterm results in patients undergoing coronary bypass graft and mitral valve annuloplasty with advanced dilated cardiomyopathy. Sixty-one patients with ischemic dilated cardiomyopathy underwent coronary artery bypass...

  • Ischaemic Mitral Regurgitation and the Role of Surgical Intervention. Marasco, Silvana F. // Heart, Lung & Circulation;Dec2008 Supplement 4, Vol. 17, pS14 

    The correct management of ischaemic mitral regurgitation (IMR) in patients presenting for coronary artery bypass grafting (CABG) remains contentious. Although it is generally agreed that severe MR in patients presenting for CABG should be corrected and that mild MR can be left alone, there is no...

  • Successful Treatment of a Distal Saphenous Vein Graft Lesion Using the Proxis Embolic Protection System. Ambrose, Jay // Reviews in Cardiovascular Medicine;Summer2007, Vol. 8 Issue 3, p182 

    The article describes the case of a 73-year-old white male with a history of coronary artery bypass surgery, paroxysmal atrial fibrillation, hyperlipidemia, and renal insufficiency presented with progressive exertional chest pain relieved by rest. He underwent primary percutaneous coronary...

  • Coronary-Subclavian Steal: Case Series and Review of Diagnostic and Therapeutic Strategies: Three Case Reports. Costa, Steven M.; Fitzsimmons, Patrick J.; Terry, Edwin; Scott, Robert C. // Angiology;Apr/May2007, Vol. 58 Issue 2, p242 

    Due to the increased use of internal mammary artery grafts for coronary revascularization, proximal subclavian stenosis resulting in coronary-subclavian steal has become an important clinical entity. Patients present with varying signs and symptoms of recurrent myocardial ischemia that not only...

  • A Single-Stage Procedure for Carotid Endarterectomy and Myocardial Revascularization. Di Tommaso, Luigi; Iannelli, Gabriele; Monaco, Mario; Mottola, Michele; De Amicis, Vincenzo; Spampinato, Nicola // Texas Heart Institute Journal;2005, Vol. 32 Issue 3, p271 

    Cardiac events are some of the most frequent postoperative complications of carotid endarterectomy, while cerebrovascular accidents frequently occur in patients who have undergone coronary artery bypass grafting. The strategy for treatment of combined carotid and coronary artery disease is still...

  • Stents or Surgery. Wilson, James M. // Texas Heart Institute Journal;2005, Vol. 32 Issue 3, p331 

    Presents an article about stents as a good alternative to surgery. Background of developments in revascularization therapy; Trials of stent implantation for isolated proximal left anterior descending coronary artery stenosis; Factors affecting choice between surgery and stents.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics