Implications of a Novel Modified Strategy for Combined Coronary Artery Bypass Grafting and Mitral Valve Replacement for Ischaemic Heart Disease Patients | ||
| The Egyptian Journal of Hospital Medicine | ||
| Article 10, Volume 92, Issue 1, July 2023, Pages 5519-5527 PDF (316.62 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejhm.2023.305795 | ||
| Authors | ||
| Ahmed Saber* ; Ahmed T. Elgengehe; Eman Salah Eldin Elsakaan; Hisham M. Elbatanony | ||
| Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt | ||
| Abstract | ||
| Background: Conventional coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) is the best definitive treatment for patients with ischemic heart disease (IHD) complicated with severe ischemic mitral regurgitation (IMR). Yet the procedure itself entails high intraoperative and early postoperative risks added to the higher preoperative risk profile of its candidates. The higher risk values are largely attributed to the longer duration taken for the combined procedures with mandatory prolonged aortic cross clamping time with the risk of longer cardiac arrest state and prolonged cardiopulmonary bypass (CPB) time. Objective: This study primarily aimed at tracing the impact of a modified strategy adopting CABG on beating on-pumped non-aortic cross clamped heart conserving cardiac ischemia only for the MVR step of the surgery. Patients and Methods: This retrospective observational non-randomized study included 56 patients presented with IHD complicated with severe IMR. They had been operated upon by CABG and MVR. They had anginal pain grade III according to Canadian Cardiovascular Society (CCS) grading of angina pectoris. Intraoperative aortic cross clamping time, CPB time and mortality, postoperative mortality, morbidity outcomes, overall hospital complications rate, left ventricular ejection fraction per cent (LVEF%), CCS grading and overall one-year survival rate were evaluated. Results: No intraoperative mortality happened. The in-hospital mortality was 5.35%. Multivariable analysis showed that old age (OR: 1.15 (95% CI: 1.090-1.210); p < /em>= 0.001), females (OR: 3.25 (95% CI: 1.030-10.801); p < /em>= 0.041) and critical preoperative condition (OR: 3.78 (95% CI: 1.179-12.798); p < /em>= 0.027) were the foreshows of operative mortality and showed that old age (OR: 1.16 (95% CI: 1.100-1.122); p < /em>= 0.001) and critical preoperative condition (OR: 4.68 (95% CI: 1.378-15.395); p < /em>= 0.008) were those of in-hospital morbidity. The overall hospital complication rate was 23.21%. The overall one-year survival rate was 94.64% with statistically significant improvement of LVEF% with a mean 51.53±3.41 (p < 0.001) and CCS grade whereas 92.45% were in CCS grade I and 7.54% in CCS grade II (p < 0.001). Conclusion: The adopted stepwise approach showed markedly better operative and postoperative outcomes than reported with statistically significant improvement in both functional clinical statuses, LVEF% and survival at one-year follow-up. | ||
| Keywords | ||
| Combined CABG and MVR; Severe IMR; Complicated IHD | ||
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