Fevzi TORAMAN, Ali BUTURAK, Murat ÖKTEN, Cem ARITÜRK, Selçuk GÖRMEZ, Şahin ŞENAY, Ümit GÜLLLÜ, Hasan KARABULUT, Cem ALHAN

Mitral valve repair for ischemic mitral insufficiency: An increased early postoperative risk for the elderly

Amaç: Bu çalışmada, iskemik kalp hastalığı ve iskemikmitral yetersizliği bulunan hastalarda koroner arterbaypas greftleme (KABG) ve tam veya kısmi mitralhalka annüloplasti ameliyatının erken dönem sonuçları(ameliyattan sonra ilk 30 gün) değerlendirildi ve mortaliteiçin risk faktörleri belirlendi.Çalışmaplanı: Haziran 2000 - Mayıs 2012 tarihleriarasında iskemik kalp hastalığı ve orta ila şiddetli iskemikmitral yetersizliği olan ardışık 180 hastaya eş zamanlıCABG ve tam veya kısmi mitral halka anüloplastisiuygulandı. Prospektif olarak toplanan veriler retrospektifolarak erken dönem sonuçlar açısından değerlendirildi.Bul gu lar: Ortalama %9.2lik (dağılım 1.5-62.2) lojistikEurosSCORE değerine kıyasla, 30 günlük mortalite %6.1olarak bulundu. Yoğun bakımda kalış süresi ortalama49 (dağılım 4-576) saat, hastanede kalış süresi ortalama10 (dağılım 0-105) gün idi. Mortalitenin tek bağımsızrisk faktörü ileri yaş idi (70 yaşın üzerindeki hastalardamortalite riski, genç hastalara oranla 7.4 kat fazla bulundu;p=0.006).Sonuç: İskemik kalp hastalığı olan hastalarda orta ilaşiddetli fonksiyonel mitral yetersizlik, KABG ile kombineolarak yapılan mitral kapak tamiri ile kabul edilebilir bircerrahi risk ile tedavi edilebilir. Ancak, ileri yaş (>70 yıl),30 günlük mortalite için bağımsız bir risk faktörüdür. Budurum cerrahi planlama yapılırken göz önünde tutulmalıdır.

İskemik mitral yetme zlikte mitral kapak tamiri: Yaşlı hastalarda artmış erken ameliyat sonrası risk

Background: This study aims to evaluate our early results(first postoperative 30 days) of coronary artery bypassgrafting (CABG) and complete or partial ring mitralannuloplasty procedures and to define the mortality ratein the patients with ischemic heart disease and ischemicmitral insufficiency.Methods: Between May 2000 and May 2012, 180consecutive patients underwent simultaneous CABG andcomplete or partial mitral ring annuloplasty for ischemicheart disease and moderate to severe ischemic mitralinsufficiency. Prospectively collected data were analyzedretrospectively in terms of early outcomes.Results: Thirty days mortality rate was 6.1% comparedto a mean logistic EuroSCORE value of 9.2% (range 1.5to 62.2). The mean intensive care unit and hospital stayswere 49 (range 4 to 576) hours and 10 (range 0 to 105)days, respectively. The only independent risk factor formortality was increased age (7.4 times higher mortalityrate in patients aged more than 70 years compared to theyounger patients, p=0.006).Conclusion: Moderate to severe functional mitralregurgitation in ischemic heart disease may be treated withmitral valve repair combined with CABG with acceptableoperative risk. However, advanced age (>70 years old) is anindependent risk factor for 30-day mortality. This shouldbe considered for operative planning.

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1. Akar AR, Doukas G, Szafranek A, Alexiou C, Boehm MC, Chin D, et al. Mitral valve relpair and revascularization for ischemic mitral regurgitation: predictors of operative mortality and survival. J Heart Valve Dis 2002;11:793-800.
2. Akar AR, Ozyurda U. Surgery for ischemic mitral valve prolapse. Eur J Cardiothorac Surg 2005;28:361-2.
3. Maisel AS, Gilpin EA, Klein L, Le Winter M, Henning H, Collins D. The murmur of papillary muscle dysfunction in acute myocardial infarction: clinical features and prognostic implications. Am Heart J 1986;112:705-11.
4. Rankin JS, Hickey MS, Smith LR, Muhlbaier L, Reves JG, Pryor DB, et al. Ischemic mitral regurgitation. Circulation 1989;79:I116-21.
5. Tcheng JE, Jackman JD Jr, Nelson CL, Gardner LH, Smith LR, Rankin JS, et al. Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med 1992;117:18-24.
6. Bursi F, Enriquez-Sarano M, Nkomo VT, Jacobsen SJ, Weston SA, Meverden RA, et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation 2005;111:295-301.
7. Sirivella S, Gielchinsky I. Results of coronary bypass and valve operations for mitral valve regurgitation. Asian Cardiovasc Thorac Ann 2007;15:396-404.
8. Benedetto U, Melina G, Roscitano A, Fiorani B, Capuano F, Sclafani G, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta- analysis on 2479 patients. J Cardiovasc Med (Hagerstown) 2009;10:109-14.
9. Prifti E, Bonacchi M, Frati G, Giunti G, Babatasi G, Sani G. Ischemic mitral valve regurgitation grade II-III: correction in patients with impaired left ventricular function undergoing simultaneous coronary revascularization. J Heart Valve Dis 2001;10:754-62.
10. Paperella D, Mickleborough LL, Carson S, Ivanow J. Mild to moderate mitral regurgitation in patients undergoing coronary bypass grafting: effects on operative mortality and long-term significance. Ann Thorac Surg 2003;76:1094-100.
11. Adams DH, Filsoufi F, Aklog L. Surgical treatment of the ischemic mitral valve. J Heart Valve Dis 2002;11:21-5.
12. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118:523-661.
13. Chan KM, Punjabi PP, Flather M, Wage R, Symmonds K, Roussin I, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation 2012;126:2502-10.
14. Talwalkar NG, Earle NR, Earle EA, Lawrie GM. Mitral valve repair in patients with low left ventricular ejection fractions: early and late results. Chest 2004;126:709-15.
15. Dahlberg PS, Orszulak TA, Mullany CJ, Daly RC, Enriquez- Sarano M, Schaff HV. Late outcome of mitral valve surgery for patients with coronary artery disease. Ann Thorac Surg 2003;76:1539-487.
16. Maltais S, Schaff HV, Daly RC, Suri RM, Dearani JA, Sundt TM 3rd, et al. Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. J Thorac Cardiovasc Surg 2011;142:995-1001.
17. Gummert JF, Rahmel A, Bucerius J, Onnasch J, Doll N, Walther T, et al. Mitral valve repair in patients with end stage cardiomyopathy: who benefits? Eur J Cardiothorac Surg 2003;23:1017-22.
18. Crabtree TD, Bailey MS, Moon MR, Munfakh N, Pasque MK, Lawton JS, et al. Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann Thorac Surg 2008;85:1537-42.