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Mitral valve surgery with or without coronary bypass grafting: eight-year cohort study.
N Z Med J 2019; 132(1500):50-58NZ

Abstract

AIMS

A significant minority of patients undergoing mitral valve surgery (MVR) have indication for coronary artery bypass grafting (CABG). The risks of combination surgeries are not well appreciated and maybe more than additive. We compared the characteristics and outcomes of MVR+/-CABG performed at our centre.

METHODS

Consecutive patients undergoing isolated MVR or with concurrent (MVR+)CABG at Auckland City Hospital during 2005-2012 were compared for baseline and operative characteristics and outcomes in univariable and multivariable analyses.

RESULTS

A total of 178 MVR+CABG and 407 MVR patients were included. MVR+CABG patients had higher age, CCS and NYHA Class, cardiopulmonary bypass time, and higher prevalence of urgent surgery, hypertension, diabetes, renal impairment, myocardial infarction/coronary artery disease, congestive heart failure/impaired ejection fraction and peripheral vascular disease, although lower prevalence of active endocarditis and previous valve surgery (all P<0.05). MVR+CABG had higher mortality (operative 11.2% vs 2.5% P<0.001; one and five-year survival 85% vs 96% and 78% vs 87% P=0.041) and composite morbidity 53.4% vs 18.9% P<0.001, including acute renal failure, prolonged ventilation, return to theatre (all P<0.001) but not stroke. In multivariable analyses, MVR+CABG was independently associated with higher operative mortality odds ratio 2.07 95% confidence interval 1.09-3.93 and composite morbidity 2.38 (1.03-5.47), but not long-term mortality.

CONCLUSION

MVR+CABG compared to MVR patients had more comorbidities and greater operative risk, and were independently associated with higher operative mortality and composite morbidity, but not independently associated with higher long-term mortality.

Authors+Show Affiliations

Cardiologist, Department of Cardiology, Middlemore Hospital (previous Cardiology Advanced Trainee Registrar, Green Lane Cardiovascular Service, Auckland City Hospital), Auckland.Cardiology Advanced Trainee Registrar, Department of Cardiology, Tauranga Hospital, Tauranga.Anaesthetic Registrar, Department of Anaesthetics, Auckland City Hospital, Auckland.Renal Advanced Trainee Registrar, Department of Renal Medicine, Auckland City Hospital, Auckland.Clinical Director Cardiothoracic Surgeon, Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland.Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31415499

Citation

Wang, Tom Kai Ming, et al. "Mitral Valve Surgery With or Without Coronary Bypass Grafting: Eight-year Cohort Study." The New Zealand Medical Journal, vol. 132, no. 1500, 2019, pp. 50-58.
Wang TKM, Liao YB, Choi D, et al. Mitral valve surgery with or without coronary bypass grafting: eight-year cohort study. N Z Med J. 2019;132(1500):50-58.
Wang, T. K. M., Liao, Y. B., Choi, D., Harmos, S., Haydcok, D., & Gerber, I. (2019). Mitral valve surgery with or without coronary bypass grafting: eight-year cohort study. The New Zealand Medical Journal, 132(1500), pp. 50-58.
Wang TKM, et al. Mitral Valve Surgery With or Without Coronary Bypass Grafting: Eight-year Cohort Study. N Z Med J. 2019 Aug 16;132(1500):50-58. PubMed PMID: 31415499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitral valve surgery with or without coronary bypass grafting: eight-year cohort study. AU - Wang,Tom Kai Ming, AU - Liao,Yi-Wen Becky, AU - Choi,David, AU - Harmos,Sophie, AU - Haydcok,David, AU - Gerber,Ivor, Y1 - 2019/08/16/ PY - 2019/8/16/entrez PY - 2019/8/16/pubmed PY - 2019/8/16/medline SP - 50 EP - 58 JF - The New Zealand medical journal JO - N. Z. Med. J. VL - 132 IS - 1500 N2 - AIMS: A significant minority of patients undergoing mitral valve surgery (MVR) have indication for coronary artery bypass grafting (CABG). The risks of combination surgeries are not well appreciated and maybe more than additive. We compared the characteristics and outcomes of MVR+/-CABG performed at our centre. METHODS: Consecutive patients undergoing isolated MVR or with concurrent (MVR+)CABG at Auckland City Hospital during 2005-2012 were compared for baseline and operative characteristics and outcomes in univariable and multivariable analyses. RESULTS: A total of 178 MVR+CABG and 407 MVR patients were included. MVR+CABG patients had higher age, CCS and NYHA Class, cardiopulmonary bypass time, and higher prevalence of urgent surgery, hypertension, diabetes, renal impairment, myocardial infarction/coronary artery disease, congestive heart failure/impaired ejection fraction and peripheral vascular disease, although lower prevalence of active endocarditis and previous valve surgery (all P<0.05). MVR+CABG had higher mortality (operative 11.2% vs 2.5% P<0.001; one and five-year survival 85% vs 96% and 78% vs 87% P=0.041) and composite morbidity 53.4% vs 18.9% P<0.001, including acute renal failure, prolonged ventilation, return to theatre (all P<0.001) but not stroke. In multivariable analyses, MVR+CABG was independently associated with higher operative mortality odds ratio 2.07 95% confidence interval 1.09-3.93 and composite morbidity 2.38 (1.03-5.47), but not long-term mortality. CONCLUSION: MVR+CABG compared to MVR patients had more comorbidities and greater operative risk, and were independently associated with higher operative mortality and composite morbidity, but not independently associated with higher long-term mortality. SN - 1175-8716 UR - https://www.unboundmedicine.com/medline/citation/31415499/Mitral_valve_surgery_with_or_without_coronary_bypass_grafting:_eight-year_cohort_study DB - PRIME DP - Unbound Medicine ER -