| Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting. | |
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MedLine Citation:
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PMID: 16159834 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jacob N Schroder; Matthew L Williams; Jonathan A Hata; Lawrence H Muhlbaier; Madhav Swaminathan; Joseph P Mathew; Donald D Glower; Christopher M O'Connor; Peter K Smith; Carmelo A Milano |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 112 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-09-14 Completed Date: 2006-02-21 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: I293-8 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27703, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Cohort Studies Coronary Artery Bypass / statistics & numerical data* Coronary Disease / complications, surgery* Echocardiography, Transesophageal* Female Follow-Up Studies Heart Failure / epidemiology, etiology Humans Life Tables Male Middle Aged Mitral Valve Insufficiency / complications*, ultrasonography Phenylephrine / administration & dosage Postoperative Complications / epidemiology, etiology Proportional Hazards Models Prospective Studies Risk Factors Survival Analysis Treatment Outcome Ultrasonography, Interventional* |
| Chemical | |
Reg. No./Substance:
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59-42-7/Phenylephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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