Mid- and long-term efficacy of off-pump coronary artery bypass grafting in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Wei , ZHANG Kui , ZHAO Yang , MU Junsheng ,  DONG Ran

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

DONG Ran, Email: drdongran@126.com

Keywords：

Moderate ischemic mitral regurgitation; coronary artery disease; off-pump coronary artery bypass grafting; elderly patients

DOI：

10.7507/1007-4848.202108010

Video：

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Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantlyimproved (2.5±1.8 cm² vs. 5.6±1.0 cm², P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P＜0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.

Citation： FU Wei, ZHANG Kui, ZHAO Yang, MU Junsheng, DONG Ran. Mid- and long-term efficacy of off-pump coronary artery bypass grafting in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 982-988. doi: 10.7507/1007-4848.202108010 Copy

1.	Vajapey R, Kwon D. Guide to functional mitral regurgitation: A contemporary review. Cardiovasc Diagn Ther, 2021, 11(3): 781-792.
2.	Hadjadj S, Marsit O, Paradis JM, et al. Pathophysiology, diagnosis, and new therapeutic approaches for ischemic mitral regurgitation. Can J Cardiol, 2021, 37(7): 968-979.
3.	Brescia AA, Watt TMF, Bolling SF. Ischemic mitral regurgitation: Current understanding and surgical options. Indian J Thorac Cardiovasc Surg, 2020, 36(Suppl 1): 27-33.
4.	于春宇, 郑哲. 中度缺血性二尖瓣反流手术治疗的现状分析. 中国胸心血管外科临床杂志, 2019, 26(7): 723-727.
5.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
6.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
7.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
8.	Barandon L, Richebé P, Munos E, et al. Off-pump coronary artery bypass surgery in very high-risk patients: Adjustment and preliminary results. Interact Cardiovasc Thorac Surg, 2008, 7(5): 789-793.
9.	Yap CH, Yan BP, Akowuah E, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv, 2009, 2(8): 758-764.
10.	Báez-Ferrer N, Izquierdo-Gómez MM, Marí-López B, et al. Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: A review. J Thorac Dis, 2018, 10(12): 6969-6986.
11.	Sandoval Y, Sorajja P, Harris KM. Contemporary management of ischemic mitral regurgitation: A review. Am J Med, 2018, 131(8): 887-895.
12.	Castleberry AW, Williams JB, Daneshmand MA, et al. Surgical revascularization is associated with maximal survival in patients with ischemic mitral regurgitation: A 20-year experience. Circulation, 2014, 129(24): 2547-2556.
13.	Salmasi MY, Harky A, Chowdhury MF, et al. Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery? J Card Surg, 2018, 33(7): 374-384.
14.	Rosenthal J. Aging and the cardiovascular system. Gerontology, 1987, 33 Suppl 1: 3-8.
15.	Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 60-77.
16.	王俊华, 吕晶. 非体外循环下与体外循环下冠状动脉旁路移植术对患者心肌和肾功能影响的对比研究. 心脑血管病防治, 2021, 21(1): 53-56.
17.	Seki T, Yoshida T. Comparison of mid-term graft patency between on-pump and off-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg, 2017, 23(3): 141-148.
18.	Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
19.	Bowles BJ, Lee JD, Dang CR, et al. Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. Chest, 2001, 119(1): 25-30.
20.	Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2016, 375(24): 2359-2368.
21.	Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
22.	Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: Final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation, 2012, 126(21): 2502-2510.
23.	Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2014, 371(23): 2178-2188.

1. Vajapey R, Kwon D. Guide to functional mitral regurgitation: A contemporary review. Cardiovasc Diagn Ther, 2021, 11(3): 781-792.
2. Hadjadj S, Marsit O, Paradis JM, et al. Pathophysiology, diagnosis, and new therapeutic approaches for ischemic mitral regurgitation. Can J Cardiol, 2021, 37(7): 968-979.
3. Brescia AA, Watt TMF, Bolling SF. Ischemic mitral regurgitation: Current understanding and surgical options. Indian J Thorac Cardiovasc Surg, 2020, 36(Suppl 1): 27-33.
4. 于春宇, 郑哲. 中度缺血性二尖瓣反流手术治疗的现状分析. 中国胸心血管外科临床杂志, 2019, 26(7): 723-727.
5. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
6. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
7. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
8. Barandon L, Richebé P, Munos E, et al. Off-pump coronary artery bypass surgery in very high-risk patients: Adjustment and preliminary results. Interact Cardiovasc Thorac Surg, 2008, 7(5): 789-793.
9. Yap CH, Yan BP, Akowuah E, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv, 2009, 2(8): 758-764.
10. Báez-Ferrer N, Izquierdo-Gómez MM, Marí-López B, et al. Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: A review. J Thorac Dis, 2018, 10(12): 6969-6986.
11. Sandoval Y, Sorajja P, Harris KM. Contemporary management of ischemic mitral regurgitation: A review. Am J Med, 2018, 131(8): 887-895.
12. Castleberry AW, Williams JB, Daneshmand MA, et al. Surgical revascularization is associated with maximal survival in patients with ischemic mitral regurgitation: A 20-year experience. Circulation, 2014, 129(24): 2547-2556.
13. Salmasi MY, Harky A, Chowdhury MF, et al. Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery? J Card Surg, 2018, 33(7): 374-384.
14. Rosenthal J. Aging and the cardiovascular system. Gerontology, 1987, 33 Suppl 1: 3-8.
15. Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 60-77.
16. 王俊华, 吕晶. 非体外循环下与体外循环下冠状动脉旁路移植术对患者心肌和肾功能影响的对比研究. 心脑血管病防治, 2021, 21(1): 53-56.
17. Seki T, Yoshida T. Comparison of mid-term graft patency between on-pump and off-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg, 2017, 23(3): 141-148.
18. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
19. Bowles BJ, Lee JD, Dang CR, et al. Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. Chest, 2001, 119(1): 25-30.
20. Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2016, 375(24): 2359-2368.
21. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
22. Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: Final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation, 2012, 126(21): 2502-2510.
23. Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2014, 371(23): 2178-2188.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid- and long-term efficacy of off-pump coronary artery bypass grafting in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation

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