Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization

Eugene A. Grossi, Gregory A. Crooke, Paul L. DiGiorgi, Charles F. Schwartz, Ulrich P. Jorde, Robert M. Applebaum, Greg H. Ribakove, Aubrey C. Galloway, Juan B. Grau, Stephen B. Colvin

Research output: Contribution to journalArticle

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Abstract

BACKGROUND - Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS - From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (expβ = 1.34; P=0.033). CONCLUSIONS - Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

Original languageEnglish (US)
JournalCirculation
Volume114
Issue numberSUPPL. 1
DOIs
StatePublished - Jul 2006
Externally publishedYes

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Mitral Valve Insufficiency
Coronary Artery Bypass
Thoracic Surgery
Survival
Heart Failure
Kidney
Ventricular Function
Social Security
Transesophageal Echocardiography
Left Ventricular Dysfunction
Hospital Mortality
Vascular Diseases
Uncertainty
Odds Ratio
Pathology

Keywords

  • Ischemia
  • Mitral valve
  • Regurgitation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Grossi, E. A., Crooke, G. A., DiGiorgi, P. L., Schwartz, C. F., Jorde, U. P., Applebaum, R. M., ... Colvin, S. B. (2006). Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 114(SUPPL. 1). https://doi.org/10.1161/CIRCULATIONAHA.105.001230

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. / Grossi, Eugene A.; Crooke, Gregory A.; DiGiorgi, Paul L.; Schwartz, Charles F.; Jorde, Ulrich P.; Applebaum, Robert M.; Ribakove, Greg H.; Galloway, Aubrey C.; Grau, Juan B.; Colvin, Stephen B.

In: Circulation, Vol. 114, No. SUPPL. 1, 07.2006.

Research output: Contribution to journalArticle

Grossi, EA, Crooke, GA, DiGiorgi, PL, Schwartz, CF, Jorde, UP, Applebaum, RM, Ribakove, GH, Galloway, AC, Grau, JB & Colvin, SB 2006, 'Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization', Circulation, vol. 114, no. SUPPL. 1. https://doi.org/10.1161/CIRCULATIONAHA.105.001230
Grossi, Eugene A. ; Crooke, Gregory A. ; DiGiorgi, Paul L. ; Schwartz, Charles F. ; Jorde, Ulrich P. ; Applebaum, Robert M. ; Ribakove, Greg H. ; Galloway, Aubrey C. ; Grau, Juan B. ; Colvin, Stephen B. / Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. In: Circulation. 2006 ; Vol. 114, No. SUPPL. 1.
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abstract = "BACKGROUND - Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS - From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5{\%}) with no MR, 1137 (50.7{\%}) with mild MR, and 264 (11.8{\%}) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (expβ = 1.34; P=0.033). CONCLUSIONS - Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.",
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AU - Crooke, Gregory A.

AU - DiGiorgi, Paul L.

AU - Schwartz, Charles F.

AU - Jorde, Ulrich P.

AU - Applebaum, Robert M.

AU - Ribakove, Greg H.

AU - Galloway, Aubrey C.

AU - Grau, Juan B.

AU - Colvin, Stephen B.

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N2 - BACKGROUND - Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS - From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (expβ = 1.34; P=0.033). CONCLUSIONS - Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

AB - BACKGROUND - Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS - From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (expβ = 1.34; P=0.033). CONCLUSIONS - Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

KW - Ischemia

KW - Mitral valve

KW - Regurgitation

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