Multiple percutaneous coronary interventions worsen outcomes for subsequent surgical correction of chronic ischemic mitral regurgitationCentral MessagePerspective

JTCVS Open

Koichi Toda, MD, PhD¹  Takafumi Masai²  Toshihiro Funatsu²  Hiroki Hata²  Hiroyuki Nishi²  Masashi Kawamura²  Yukitoshi Shirakawa²  Toshiki Takahashi²  Takashi Yamauchi²  Osamu Monta²  Hidetaka Kioka, MD, PhD³  Seiko Ide, MD, PhD³  Haruhiko Kondoh, MD, PhD³  Yoshiki Sawa, MD, PhD³  Tomohito Ohtani, MD, PhD³  Shungo Hikoso, MD, PhD³  Isamu Mizote, MD, PhD³  Yasushi Sakata, MD, PhD⁴  Arudo Hiraoka, MD, PhD⁴  Ai Kawamura, MD, PhD⁵  Yasushi Yoshikawa⁵  Kensuke Yokoi, MD, PhD⁵  Satoshi Kainuma, MD, PhD⁵  Shigeru Miyagawa, MD, PhD⁵  Daisuke Yoshioka, MD, PhD⁵  Toru Kuratani, MD, PhD⁵  Takuji Kawamura, MD, PhD⁵  Noriyuki Kashiyama, MD, PhD⁵  Hidenori Yoshitaka, MD, PhD⁶  Taichi Sakaguchi, MD, PhD⁶  Tetsuhisa Kitamura, MD, DPH, MS⁶  Atsushi Hirayama, MD, MPH⁷  Sho Komukai, PhD⁸  Kazuhiro Taniguchi, MD, PhD⁹ 

[1] Address for reprints: Satoshi Kainuma, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.;;Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan;Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan;Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;

关键词: ischemic mitral regurgitation;    percutaneous coronary intervention;    restrictive mitral annuloplasty;    left ventricular reverse remodeling;    coronary artery bypass grafting;   

DOI  :  

来源: DOAJ

【 摘 要 】

Objective: We investigated whether or not a history of multiple percutaneous coronary interventions (PCIs) is associated with clinical outcomes after surgery for ischemic mitral regurgitation. Methods: A total of 309 patients with chronic ischemic mitral regurgitation and left ventricular ejection fraction ≤40% who underwent restrictive mitral annuloplasty were classified as follows: patients with no or 1 previous PCI (nonmultiple PCI group [n = 211]) and patients with 2 or more previous PCIs (multiple PCIs group [n = 98]). Mean follow-up duration was 53 ± 40 months. Results: Before surgery, there were no intergroup differences in patient demographic characteristics except for lower estimated glomerular filtration rate in patients with multiple PCIs. These patients underwent concomitant coronary artery bypass grafting less frequently with a lower number of distal anastomoses (P < .05 for both). The 30-day mortality was 3.3% and 2.0% in the nonmultiple and multiple PCIs group, respectively (P = .72). During follow-up, there were 157 deaths. Patients with multiple PCIs showed lower 5-year survival rate (44% vs 64%; P = .002). After adjustments with inverse-probability-of-treatment weighting, multiple PCIs history was an independent risk factor for mortality (adjusted hazard ratio, 1.4; 95% confidential interval, 1.1-1.7; P = .002). Patients with multiple PCIs showed less improvement in left ventricular ejection fraction (interaction effect P < .001). Conclusions: In patients with ischemic mitral regurgitation, a history of previous multiple PCIs was associated with increased risk of long-term postoperative mortality, with less improvement in left ventricular ejection fraction.

【 授权许可】

Unknown