Document Detail


Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting.
MedLine Citation:
PMID:  16159834     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-09-14     Completed Date:  2006-02-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I293-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27703, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
59-42-7/Phenylephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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