JTCVS Open (Sep 2021)

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

  • Satoshi Kainuma, MD, PhD,
  • Koichi Toda, MD, PhD,
  • Shigeru Miyagawa, MD, PhD,
  • Daisuke Yoshioka, MD, PhD,
  • Takuji Kawamura, MD, PhD,
  • Ai Kawamura, MD, PhD,
  • Noriyuki Kashiyama, MD, PhD,
  • Toru Kuratani, MD, PhD,
  • Kensuke Yokoi, MD, PhD,
  • Seiko Ide, MD, PhD,
  • Isamu Mizote, MD, PhD,
  • Hidetaka Kioka, MD, PhD,
  • Tomohito Ohtani, MD, PhD,
  • Shungo Hikoso, MD, PhD,
  • Haruhiko Kondoh, MD, PhD,
  • Arudo Hiraoka, MD, PhD,
  • Taichi Sakaguchi, MD, PhD,
  • Hidenori Yoshitaka, MD, PhD,
  • Tetsuhisa Kitamura, MD, DPH, MS,
  • Sho Komukai, PhD,
  • Atsushi Hirayama, MD, MPH,
  • Kazuhiro Taniguchi, MD, PhD,
  • Yasushi Sakata, MD, PhD,
  • Yoshiki Sawa, MD, PhD,
  • Yasushi Yoshikawa,
  • Hiroki Hata,
  • Toshihiro Funatsu,
  • Takafumi Masai,
  • Yukitoshi Shirakawa,
  • Toshiki Takahashi,
  • Hiroyuki Nishi,
  • Masashi Kawamura,
  • Osamu Monta,
  • Takashi Yamauchi

Journal volume & issue
Vol. 7
pp. 195 – 206

Abstract

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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.

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