| Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation. | |
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MedLine Citation:
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PMID: 16039207 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR. METHODS: We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3+ ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed. RESULTS: Actuarial 1-, 5-, and 10-year survival was 84.0%, 67.5%, and 37.1% in the overall group of 251 patients. Independent predictors of long-term mortality were age 70 years or more (hazard ratio 2.50 [95% confidence interval 1.82 to 3.44]), prior myocardial infarction (3.99 [2.15 to 7.39]), unstable angina (2.27 [1.69 to 3.04]), chronic renal failure (4.87 [3.13 to 7.58]), atrial fibrillation (2.21 [1.65 to 2.96]), left internal mammary artery to left anterior descending artery graft (0.28 [0.18 to 0.43]), preoperative beta-blocker (0.43 [0.28 to 0.67]), ejection fraction (0.71/10% [0.64 to 0.80]), left atrium size (0.88/mm [0.84 to 0.92]), diffuse wall motion abnormalities (2.83 [1.77 to 4.55]), and mitral leaflet restriction (3.85 [2.46 to 5.99]). The model controlled for the performance of annuloplasty, which did not emerge as an independent predictor. Patients undergoing annuloplasty did have less mean late MR than those having CABG alone (p = 0.005). Overall, 57.8% of patients (63 of 109) with follow-up echocardiograms had improvement in grade of MR compared with baseline. In 54 of 95 patients (56.8%), intraoperative transesophageal echocardiography downgraded the degree of MR compared with the preoperative study. CONCLUSIONS: Patients with moderate ischemic MR undergoing CABG had relatively poor long-term survival, with significant differences when stratified according to preoperative characteristics. Performance of mitral annuloplasty reduced the degree of regurgitation but was not a predictor of long-term survival. Intraoperative transesophageal echocardiography frequently downgraded the degree of MR. |
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Authors:
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Daniel R Wong; Arvind K Agnihotri; Judy W Hung; Gus J Vlahakes; Cary W Akins; Alan D Hilgenberg; Joren C Madsen; Thomas E MacGillivray; Michael H Picard; David F Torchiana |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 80 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-07-25 Completed Date: 2006-09-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 570-7 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Surgical Procedures / mortality Coronary Artery Bypass / mortality* Female Humans Mitral Valve Insufficiency / etiology, surgery* Myocardial Ischemia / complications, surgery* Retrospective Studies Survival Analysis Time Factors |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2005 Aug;80(2):577-8
[PMID:
16039208
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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