Coronary Artery Bypass Grafting with Mitral Annuloplasty or Replacement for Ischemic Mitral Regurgitation in Medicare Beneficiaries.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-02-08 DOI:10.1016/j.athoracsur.2025.01.021

Timothy J George, John J Squiers, J Michael DiMaio, Jasjit K Banwait, Paul A Grayburn, Michael J Mack, Justin M Schaffer

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引用次数: 0

Abstract

Background: Retrospective studies of patients with ischemic mitral regurgitation(iMR) undergoing coronary artery bypass grafting(CABG) with concomitant mitral valve surgery frequently report improved survival with mitral valve annuloplasty(MVr) over replacement(MVR). However, the only randomized controlled trial found no survival difference.

Methods: Medicare claims data were queried to identify beneficiaries with iMR undergoing CABG+MVr or CABG+MVR. Kaplan-Meier estimates of survival after CABG+MVr and CABG+MVR were generated, and 20-year restricted mean survival times(RMST) were compared. Then, surgeons were stratified by their rate of CABG/MVr into groups with a demonstrated preference for MVr(PA) or MVR(PR). Outcomes were re-analyzed by surgeon preference. Overlap propensity score weighting was used for risk-adjustment in all analyses.

Results: Among 10,471 beneficiaries with iMR, 6,457(61.7%) underwent CABG+MVr and 4,014(38.3%) underwent CABG+MVR. Risk-adjusted RMSTs were 6.02[5.77,6.26] versus 5.57[5.33,5.81] years after CABG+MVr and CABG+MVR, respectively(difference 5.4[1.2,9.4] months, p=0.01). Among 1,118 surgeons, 223 PA(performed 2,191 surgeries; 89.5% MVr rate) and 235 PR(performed 1,930 surgeries; 23.0% MVr rate). Risk-adjusted RMSTs were 5.76[5.36,6.15] versus 5.77[5.40,6.14] years among beneficiaries undergoing surgery by PA surgeons and PR surgeons, respectively(difference 0.1[-6.6,6.6] months, p=0.964).

Conclusions: In Medicare beneficiaries with iMR undergoing CABG+MVS, CABG+MVr was associated with improved survival, even after risk-adjustment for measured confounders. This may be due to unmeasured confounding variables affecting the decision to perform MVr or MVR, such as valvular pathology and/or severity of regurgitation. After endeavoring to account for unmeasured confounders using surgeon preference as an instrumental variable, surgeons who preferred CABG+MVr or CABG+MVR achieved similar long-term survival for their patients.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.