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Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting.

Publication ,  Journal Article
Schroder, JN; Williams, ML; Hata, JA; Muhlbaier, LH; Swaminathan, M; Mathew, JP; Glower, DD; O'Connor, CM; Smith, PK; Milano, CA
Published in: Circulation
August 30, 2005

BACKGROUND: It is unclear if mild or moderate mitral valve regurgitation (MR) should be repaired at the time of coronary artery bypass grafting (CABG). We sought to determine the long-term effect of uncorrected MR, measured by intraoperative transesophageal echocardiography (TEE), in CABG patients. METHODS AND RESULTS: Between May 1999 and September 2003, data were gathered for 3264 consecutive patients who underwent isolated CABG and had MR graded by intraoperative TEE. MR was graded on the following 5 levels: none, trace, mild, moderate, and severe. Patients who had severe MR or who underwent mitral valve surgery were eliminated from the analysis. The remaining patients were combined into the following 3 groups: none or trace, mild, and moderate MR. Preoperative and follow-up data were 99% complete. The median length of follow-up was 3.0 years. Multivariable analysis controlling for important preoperative risk factors was performed to determine predictors of death and death/hospitalization for heart failure. Increasing MR was a risk factor for death [hazard ratio (HR), 1.44; P<0.001] and death/heart failure hospitalization (HR, 1.34; P<0.01). When patients with moderate MR were eliminated from the analysis, mild MR was a risk factor for death (HR, 1.34; P=0.011) and death/hospitalization for heart failure (HR, 1.34; P<0.001). CONCLUSIONS: Even mild MR, identified by intraoperative TEE, predicts worse outcomes after CABG. Revascularization alone did not eliminate the negative long-term effects of mild MR. CABG patients with uncorrected mild or moderate MR are at increased risk for death and heart-failure hospitalization; consideration for surgical repair or more aggressive medical management and follow-up is warranted.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 30, 2005

Volume

112

Issue

9 Suppl

Start / End Page

I293 / I298

Location

United States

Related Subject Headings

  • Ultrasonography, Interventional
  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Postoperative Complications
  • Phenylephrine
  • Mitral Valve Insufficiency
  • Middle Aged
 

Citation

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Schroder, J. N., Williams, M. L., Hata, J. A., Muhlbaier, L. H., Swaminathan, M., Mathew, J. P., … Milano, C. A. (2005). Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting. Circulation, 112(9 Suppl), I293–I298. https://doi.org/10.1161/CIRCULATIONAHA.104.523472
Schroder, Jacob N., Matthew L. Williams, Jonathan A. Hata, Lawrence H. Muhlbaier, Madhav Swaminathan, Joseph P. Mathew, Donald D. Glower, Christopher M. O’Connor, Peter K. Smith, and Carmelo A. Milano. “Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting.Circulation 112, no. 9 Suppl (August 30, 2005): I293–98. https://doi.org/10.1161/CIRCULATIONAHA.104.523472.
Schroder JN, Williams ML, Hata JA, Muhlbaier LH, Swaminathan M, Mathew JP, et al. Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting. Circulation. 2005 Aug 30;112(9 Suppl):I293–8.
Schroder, Jacob N., et al. “Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting.Circulation, vol. 112, no. 9 Suppl, Aug. 2005, pp. I293–98. Pubmed, doi:10.1161/CIRCULATIONAHA.104.523472.
Schroder JN, Williams ML, Hata JA, Muhlbaier LH, Swaminathan M, Mathew JP, Glower DD, O’Connor CM, Smith PK, Milano CA. Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting. Circulation. 2005 Aug 30;112(9 Suppl):I293–I298.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 30, 2005

Volume

112

Issue

9 Suppl

Start / End Page

I293 / I298

Location

United States

Related Subject Headings

  • Ultrasonography, Interventional
  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Postoperative Complications
  • Phenylephrine
  • Mitral Valve Insufficiency
  • Middle Aged