Abstract
Background: To investigate the impact of combined degenerative mitral valve (DMV) and coronary artery bypass grafting surgery (CABG+DMV) versus DMV surgery only on in-hospital health outcome and 10-year survival.
Methods: 745 patients with DMV disease were identified. Of these, 186 (24.9%) were affected also by coronary disease receiving combined DMV+CABG. They were compared with the remaining 559 patients receiving DMV only surgery in terms of in-hospital, 1, 5, and 10-year survival. We evaluated a short-term composite outcome of hospital mortality, acute kidney injury, cerebro-vascular events and low cardiac output requiring postoperative use of intra-aortic balloon pump. In addition, we assessed mitral valve repair rates over time and their correlation with long-term survival. To minimise bias, we conducted a propensity score matching.
Results: DMV+CABG surgery was associated with a similar incidence of composite endpoint compared to DMV surgery alone (6.5 vs 5.4 %, p=0.71 in the unmatched analysis and 7.5% vs 8.2%, p=0.82 in the matched analysis). 10-year survival was 70.5 vs 68.6 % (p=0.07) for the unmatched analysis and 64.6 vs 62.5 % (p=0.9) for the matched analysis, DMV+CABG vs DMV only respectively. Mitral valve repair had a beneficial effect on short term outcomes and long-term mortality rates, regardless the presence of concomitant coronary surgery.
Conclusions: Combined DMV+CABG surgery is a very effective surgical treatment with high mitral valve repair rate. Early in-hospital outcome and long-term survival are comparable with DMV only surgery. In these combined procedures mitral valve repair is associated with better long-term survival.
Methods: 745 patients with DMV disease were identified. Of these, 186 (24.9%) were affected also by coronary disease receiving combined DMV+CABG. They were compared with the remaining 559 patients receiving DMV only surgery in terms of in-hospital, 1, 5, and 10-year survival. We evaluated a short-term composite outcome of hospital mortality, acute kidney injury, cerebro-vascular events and low cardiac output requiring postoperative use of intra-aortic balloon pump. In addition, we assessed mitral valve repair rates over time and their correlation with long-term survival. To minimise bias, we conducted a propensity score matching.
Results: DMV+CABG surgery was associated with a similar incidence of composite endpoint compared to DMV surgery alone (6.5 vs 5.4 %, p=0.71 in the unmatched analysis and 7.5% vs 8.2%, p=0.82 in the matched analysis). 10-year survival was 70.5 vs 68.6 % (p=0.07) for the unmatched analysis and 64.6 vs 62.5 % (p=0.9) for the matched analysis, DMV+CABG vs DMV only respectively. Mitral valve repair had a beneficial effect on short term outcomes and long-term mortality rates, regardless the presence of concomitant coronary surgery.
Conclusions: Combined DMV+CABG surgery is a very effective surgical treatment with high mitral valve repair rate. Early in-hospital outcome and long-term survival are comparable with DMV only surgery. In these combined procedures mitral valve repair is associated with better long-term survival.
| Original language | English |
|---|---|
| Journal | Annals of Thoracic Surgery |
| Early online date | 8 Apr 2020 |
| DOIs | |
| Publication status | Published - 8 Apr 2020 |
Keywords
- mitral regurgitation
- degenerative mitral valve surgery
- coronary surgery
- survival