| Institution: | 1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan;2. Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan;3. Spectrum Health, Grand Rapids, Michigan;4. Henry Ford Health System, Detroit, Michigan;1. Cardiac Surgery Department, Instituto Cardiovascular, Buenos Aires, Argentina;2. Department of Cardiovascular Anesthesia, Instituto Cardiovascular, Buenos Aires, Argentina;3. Cardiovascular Intensive Care Unit, Instituto Cardiovascular, Buenos Aires, Argentina;1. Division of Cardiac Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY;2. Division of Cardiac Surgery, Department of Surgery, Adventist HealthCare, Silver Spring, Md;1. Department of Cardiovascular Services, Nemours Children''s Health, Florida, 6535 Nemours Pkwy, Orlando, FL 32827;2. Department of Surgery, University of Central Florida College of Medicine, Orlando, Florida |
| Abstract: | BackgroundRecent guidelines for the treatment of moderate or severe ischemic mitral regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) have changed. This study assessed the real-world impact of changing guidelines on the management of IMR during CABG over time. We hypothesized that the utilization of mitral valve repair for IMR would decrease over time, whereas mitral valve replacement for severe IMR would increase.MethodsPatients undergoing CABG in a statewide collaborative database (2011-2020) were stratified by severity of IMR. Trends in mitral valve repair or replacement were evaluated. To account for differences of the patients, propensity score–matched analyses were used to compare patients with and without mitral intervention.ResultsA total of 11,676 patients met inclusion criteria, including 1355 (11.6%) with moderate IMR and 390 (3.3%) with severe IMR. The proportion of patients undergoing mitral intervention for moderate IMR decreased over time (2011, 17.7%; 2020, 7.5%; Ptrend = .001), whereas mitral replacement for severe IMR remained stable (2011, 11.1%; 2020, 13.3%; Ptrend = .14). Major morbidity was higher for patients with moderate IMR who underwent mitral intervention (29.1% vs 19.9%; P = .005). In a propensity analysis of 249 well-matched pairs, there was no difference in major morbidity (29.3% with mitral intervention vs 23.7% without; P = .16) or operative mortality (1.2% vs 2.4%; P = .5).ConclusionsConsistent with recent guideline updates, patients with moderate IMR were less likely to undergo mitral repair. However, the rate of replacement for severe IMR did not change. Mitral intervention during CABG did not increase operative mortality or morbidity. |
