Experience of the management of coronary artery bypass graft
To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.

109 patients with coronary artery disease (CAD) were retrospectively analyzed complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.

Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ± 17.98 months (range 36–96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.

Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.

Source: Medicine: April 2019 - Volume 98 - Issue 17 - p e14969

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