Does The Preoperative Transthoracic Or Transesophageal Echocardiogram Better Predict Mortality After Non-Mitral Valve Cardiac Surgery?
Shyamal Asher, Huan Wang, Gregory Malzberg, Prem Shekar, Tsuyoshi Kaneko, Stan Shernan, Jochen Muehlschlegel, Simon C. Body.
Brigham and Women's Hospital, Boston, MA, USA.
It is not clear if performing additional mitral valve surgery for moderate or severe mitral regurgitation (MR) during CABG or aortic valve surgery provides additional benefit.
The aims of this study were to: (1) assess whether MR severity measured with preoperative transthoracic echocardiogram (TTE) or intraoperative transesophageal echocardiography (TEE) better predicted postoperative mortality (2) compare mortality in patients who did or did not undergo a mitral procedure for moderate or worse MR.
MethodsMedical records of patients undergoing CABG and/or AVR surgery between 2002-2016 were reviewed. Patients were excluded if they had prior MV surgery or underwent other, or concurrent, non-mitral or non-aortic valve surgery or preoperative TTE or intraoperative TEE were not present for review. Preoperative TTE and intraoperative TEE assessment of MR was classified as less than moderate, moderate or severe. MR was classified as primary, secondary or mixed/indeterminate disease. Association of MR severity with postoperative mortality was analyzed using proportional hazards regression, stratified by whether or not they concurrent mitral valve surgery.
The study cohort comprised 6,794 patients (85% male), aged 68 (10-90%; 50-83 years) with 6.7 (10-90%; 2.1-12.4) years of follow-up. 1,323 patients underwent concurrent mitral repair or replacement. There were significant differences in patient characteristics between the MR severity grades. Overall, patients who underwent a concurrent mitral procedure had improved survival, when stratified by MR severity. When a mitral valve procedure was not performed, worse MR grade is associated with worse survival. When stratified by severity of MR, mortality was marginally better associated with the intraoperative TEE measurement of MR severity than preoperative TTE measurement of MR severity.
Patients with moderate or severe MR assessed by preoperative TEE had a lower risk of mortality when the mitral valve was repaired or replaced. Patients with moderate or worse MR had a lower survival probability when mitral valve surgery was not performed. These findings support concurrent repair of moderate or worse MR when performing CABG and/or AVR.
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