Possible Effect of CABG on Moderate Mitral Regurgitation

Document Type: Original Article

Authors

1 Hematologist, Department of Transfusion Medicine, Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany

2 Nursing, Department of Nursing and Midwifery, Falavarjan Branch, Islamic Azad University, Isfahan, Iran

3 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Faculty of Medical Sciences, Islamic Azad University -Tonekabon Branch, Mazandaran, Iran

Abstract

Introduction: Mitral valve insufficiency in adults is often a complication of ischemic heart disease. Coronary artery bypass grafting (CABG) is performed as a strategy for the treatment of coronary artery disease. The aim of this study was to evaluate mitral regurgitation (MR) before and after CABG.
Materials and Methods: This Experimental study was conducted on 100 patients who underwent CABG in University Hospitals of Tehran, Iran, from 2009 to 2013. Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Chicago, IL) for Windows was used for data analysis..
Results: Out of 100 patients (i.e., 60 males and 40 females) with the mean age of 64.97±10.64 years, 11 males (18.3%) and 12 females (30.0%) were identified with MR +2 after the surgery. There was no significant relationship between renal insufficiency and MR before the operation (P= 0.370). Furthermore, in patients with and without renal insufficiency, 2 (50.0%) and 21 (21.9%) subjects were identified with MR +2 after the operation, respectively. Out of 100 patients, 75 (75%) cases with MR +2 before the surgery were identified with MR +1 after the operation. Moreover, 23 (23%) subjects with MR +2 before the surgery were still reported with MR +2 after the operation. In this regard, there was a significant relationship before and after the surgery in MR severity (P=0.02).
Conclusion: It is necessary to have sufficient knowledge of the risk factors in dealing with MR for the determination of the best therapy.

Keywords


1.         Shahverdi E, Dadjoo Y, Farahani MM, Taghipoor H, Noori MK, Konjedi MA. Coronary bypass occlusion and predisposing factors. Res Cardiovasc Med. 2016; 2:88.

2.         Nalysnyk L, Fahrbach K, Reynolds MW, Zhao SZ, Ross S. Adverse events in coronary artery bypass graft (CABG) trials: a systematic review and analysis. Heart. 2003; 89:767-72.

3.         Mustonen J, Suurmunne H, Kouri J, Pitkänen O, Hakala T. Impact of coronary artery bypass surgery on ischemic mitral regurgitation. Scand J Surg. 2011; 100:114-9.

4.         Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001; 103:1759-64.

5.         Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction a quantitative clinical study. Circulation. 2000; 102:1400-6.

6.         Grigioni F, Detaint D, Avierinos JF, Scott C, Tajik J, Enriquez-Sarano M. Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol. 2005; 45:260-7.

7.         Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2016; 374:1932-41.

8.         Sharif-Barfeh Z, Beigoli S, Marouzi S, Rad AS, Asoodeh A, Chamani J. Multi-spectroscopic and HPLC studies of the interaction between estradiol and cyclophosphamide with human serum albumin: binary and ternary systems. Journal of Solution Chemistry. 2017 Feb 1;46(2):488-504.

9.         Sanei H, Asoodeh A, Hamedakbari-Tusi Sh, Chamani J. Multi-spectroscopic investigations of aspirin and colchicine interactions with human hemoglobin: binary and ternary systems. J Solution Chem. 2011; 40:1905-31.

10.       Christenson J, Simonet F, Bloch A, Maurice J, Velebit V, Schmuziger M. Should a mild to moderate ischemic mitral valve regurgitation in patients with poor left ventricular function be repaired or not? J Heart Valve Dis. 1995; 4:484-8.

11.       Aklog L, Filsoufi F, Flores KQ, Chen RH, Cohn LH, Nathan NS, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation. 2001; 104:I68-75.

12.       Di Donato M, Frigiola A, Menicanti L, Boghdabi A, Badia T, Neagu A, et al. Moderate ischemic mitral regurgitation and coronary artery bypass surgery: effect of mitral repair on clinical outcome. J Heart Valve Dis. 2003; 12:272-9.

13.       Rydén T, Bech-Hanssen O, Brandrup-Wognsen G, Nilsson F, Svensson S, Jeppsson A. The importance of grade 2 ischemic mitral regurgitation in coronary artery bypass grafting. Eur J Cardiothorac Surg. 2001; 20:276-81.

14.       Kang DH, Kim MJ, Kang SJ, Song JM, Song H, Hong MK, et al. Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation. 2006; 114:I499-503.

15.       Hwang HY, Lim JH, Oh SJ, Paeng JC, Kim KB. Improved functional mitral regurgitation after off-pump revascularization in acute coronary syndrome. Ann Thorac Surg. 2012; 94:1157-65.

16.       Enriquez-Sarano M, Tajik AJ, Schaff HV, Orszulak TA, Bailey KR, Frye RL. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation. 1994; 90:830-7.

17.       Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: a clinical severity score. JAMA. 1992; 267:2344-8.

18.       Moosavi-Movahedi AA, Chamani J, Gharanfoli M, Hakimelahi GH. Differential scanning calorimetric study of the molten globule state of cytochrome c induced by sodium n-dodecyl sulfate. Thermochim Acta. 2004; 409:137-44.

19.       Loop FD, Lytle B, Cosgrove D, Goormastic M, Taylor PC, Golding LA, et al. Coronary artery bypass graft surgery in the elderly. Indications and outcome. Cleve Clin J Med. 1988; 55:23-34.

20.       Peper WA, Taylor PC, Paganini EP, Svensson LG, Ghattas MA, Loop FD. Mortality and results after cardiac surgery in patients with end-stage renal disease. Cleve Clin J Med. 1988; 55:63-7.

21.       McGee EC, Gillinov AM, Blackstone EH, Rajeswaran J, Cohen G, Najam F, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004; 128:916-24.