Objectives: To assess the influence of preoperative mitral valve function on patient outcome after coronary revascularization in the presence of severely depressed left ventricular contractility (LVEF< 35%). Methods: Four hundred and twenty patients (mean age 61±11 years) submitted to CABG with LV impairment (mean EF 24±11%, range 12-34%) were retrospectively analysed. Off-pump CABG was performed in 58 patients, whereas the majority had conventional surgical revascularization. Associated mitral valve procedures were performed in 67 cases (repair in 50 patients, and replacement in 12, respectively). Patient population and postoperative outcome were evaluated according to the preoperative hemodynamic significance of mitral valve insufficiency (absent, trivial or mild in 340 patients, and moderate or severe in 98 cases, respectively). Surgical correction of mitral defect was performed in all patients with preoperative severe mitral regurge, and in the majority of cases (74%) with moderate degree of valve insufficiency. Follow-up data were analysed with Kaplan-Meier estimation to assess global and event-free survival. Results: There were 18 hospital deaths. Mean follow-up was 62±42 months. Overall survival was 82% at 2 years, 73% at 4 years, and 65% at 6 years. The preoperative presence of hemodynamically significant mitral insufficiency showed to have a limited impact on long-term global survival as compared to minor mitral dysfunction. Conversely, it negatively affected mid-and long-term recovery of functional capacity because of higher recurrence of heart failure episodes. Conclusions: Our retrospective study indicates that hemodynamically significant mitral regurgitation concomitant to coronary artery disease and LV impairment requires an aggressive surgical management not to enhance life expectancy, but rather to improve postoperative recovery of functional capacity and of quality of life.

Influence of preoperative mitral valve function on postoperative patient outcome submitted to CABG with left ventricular dysfunction / Lorusso, R; Beghi, Cesare; Russo, Carolina; Gerometta, Ps; Folliguet, T; Gherli, Tiziano; Vitali, E; Arena, V.. - (2004), pp. 87-87. (Intervento presentato al convegno XXII Congresso Nazionale Bologna 6-9 Novembre 2004 tenutosi a Bologna, Italy. nel 6-9 Novembre 2004).

Influence of preoperative mitral valve function on postoperative patient outcome submitted to CABG with left ventricular dysfunction

BEGHI, Cesare;RUSSO, Carolina;GHERLI, Tiziano;
2004-01-01

Abstract

Objectives: To assess the influence of preoperative mitral valve function on patient outcome after coronary revascularization in the presence of severely depressed left ventricular contractility (LVEF< 35%). Methods: Four hundred and twenty patients (mean age 61±11 years) submitted to CABG with LV impairment (mean EF 24±11%, range 12-34%) were retrospectively analysed. Off-pump CABG was performed in 58 patients, whereas the majority had conventional surgical revascularization. Associated mitral valve procedures were performed in 67 cases (repair in 50 patients, and replacement in 12, respectively). Patient population and postoperative outcome were evaluated according to the preoperative hemodynamic significance of mitral valve insufficiency (absent, trivial or mild in 340 patients, and moderate or severe in 98 cases, respectively). Surgical correction of mitral defect was performed in all patients with preoperative severe mitral regurge, and in the majority of cases (74%) with moderate degree of valve insufficiency. Follow-up data were analysed with Kaplan-Meier estimation to assess global and event-free survival. Results: There were 18 hospital deaths. Mean follow-up was 62±42 months. Overall survival was 82% at 2 years, 73% at 4 years, and 65% at 6 years. The preoperative presence of hemodynamically significant mitral insufficiency showed to have a limited impact on long-term global survival as compared to minor mitral dysfunction. Conversely, it negatively affected mid-and long-term recovery of functional capacity because of higher recurrence of heart failure episodes. Conclusions: Our retrospective study indicates that hemodynamically significant mitral regurgitation concomitant to coronary artery disease and LV impairment requires an aggressive surgical management not to enhance life expectancy, but rather to improve postoperative recovery of functional capacity and of quality of life.
2004
Influence of preoperative mitral valve function on postoperative patient outcome submitted to CABG with left ventricular dysfunction / Lorusso, R; Beghi, Cesare; Russo, Carolina; Gerometta, Ps; Folliguet, T; Gherli, Tiziano; Vitali, E; Arena, V.. - (2004), pp. 87-87. (Intervento presentato al convegno XXII Congresso Nazionale Bologna 6-9 Novembre 2004 tenutosi a Bologna, Italy. nel 6-9 Novembre 2004).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2502050
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