J Thorac Dis. 2026 May 31;18(5):490. doi: 10.21037/jtd-2026-1-0358. Epub 2026 May 27.
ABSTRACT
BACKGROUND: Concomitant mitral valve surgery and coronary artery bypass grafting (CABG) remains the standard treatment for patients with severe mitral valve disease complicated by coronary artery disease. However, this combined procedure is associated with substantial perioperative risk. While off-pump or on-pump beating heart CABG may reduce aortic cross-clamp and cardiopulmonary bypass times compared with conventional on-pump arrested-heart CABG, evidence comparing these surgical strategies in combined mitral valve and CABG surgery remains limited. Therefore, this study aimed to evaluate the short-term outcomes of mitral valve surgery combined with on-pump arrested-heart CABG versus off-pump or on-pump beating heart CABG.
METHODS: A total of 473 patients who underwent concomitant CABG and mitral valve surgery were retrospectively analyzed. Among these patients, 368 patients underwent on-pump arrested-heart CABG (ONCABG group) and 105 patients underwent off-pump or on-pump beating heart CABG (BHCABG group). Covariate balancing propensity score (CBPS) and inverse probability of treatment weighting (IPTW) was utilized to reduce bias. The primary endpoints were in-hospital mortality and major perioperative complications.
RESULTS: After CBPS and IPTW adjustment, the BHCABG group demonstrated significantly shorter aortic cross-clamp times [ratio =0.765; 95% confidence interval (CI): 0.695-0.843; P<0.001] compared with the ONCABG group, lower peak high-sensitivity cardiac troponin I (hsTnI) levels (P=0.01) and serum creatinine levels (P<0.001). Notably, the risk of new-onset stroke was significantly reduced in the BHCABG group [odds ratio (OR) =0.063; 95% CI: 0.008-0.490; P=0.008]. No statistically significant differences were observed in operative time, mechanical ventilation duration, or in-hospital mortality between the two groups.
CONCLUSIONS: In patients undergoing combined mitral valve surgery and surgical coronary revascularization, off-pump revascularization or on-pump beating heart strategy is associated with attenuated myocardial injury, renal injury and a lower risk of postoperative stroke compared with the conventional on-pump technique.
PMID:42306714 | PMC:PMC13266873 | DOI:10.21037/jtd-2026-1-0358
