title: Concomitant off-pump coronary artery bypass grafting results in improved in-hospital outcomes for patients with ischemic mitral regurgitation undergoing surgery.
abstract: OBJECTIVE
  Surgical management of ischemic mitral regurgitation (IMR) has primarily consisted of revascularization with or without the addition of mitral valve repair or replacement. We hypothesize that performing off-pump coronary artery bypass (OPCAB) grafting before fixing MR improves in-hospital outcomes for patients with IMR undergoing surgery.
  
  
  METHODS
  From January 2000 through December 2010, a total of 96 consecutive patients with moderate or severe IMR, as determined by preoperative echocardiography, underwent on-pump coronary artery bypass grafting (CABG) (n = 66) or OPCAB (n = 30) revascularization with concomitant mitral valve repair or replacement. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. In addition, medical notes and charts were reviewed for all study patients.
  
  
  RESULTS
  The 2 groups had similar preoperative demographic and EuroSCORE risk-stratification characteristics. The operative mortality rate for the entire cohort was 9.4%. Patients who underwent OPCAB grafting had a lower operative mortality than those who underwent CABG (3.3% versus 12.1%; P = .006). The mean ±SD cardiopulmonary bypass time (82.7 ± 34.7 minutes versus 160.7 ± 45.2 minutes; P < .001) and cross-clamp time (49.0 ± 22.4 minutes versus 103.4 ± 39.5 minutes; P < .001) were significantly shorter in the off-pump group than in the on-pump group. The OPCAB group also had significantly less in-hospital morbidity and shorter stays in the intensive care unit and the hospital.
  
  
  CONCLUSIONS
  Our analysis shows that OPCAB grafting (compared with conventional CABG) before repairing MR is associated with favorable in-hospital outcomes for patients undergoing surgery for IMR.
authors: Department of Cardiac Surgery, Harefield Hospital, London, UK. drrajashahzad@hotmail.com
authors: Shahzad G
authors: SG
authors: Raja
authors: Mubassher
authors: M
authors: Husain
authors: Kareem
authors: K
authors: Salhiyyah
authors: Manoraj
authors: M
authors: Navaratnarajah
authors: Dimple
authors: D
authors: Chudasama
authors: Christopher P
authors: CP
authors: Walker
authors: Fouad
authors: F
authors: Amin
authors: Mohamed
authors: M
authors: Amrani
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008131:London / Q000453:epidemiology; D008297:Male; D058386:Mitral Valve Annuloplasty / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D017202:Myocardial Ischemia / Q000401:mortality* / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome