Background and aim: Surgical repair of secondary mitral regurgitation is still controversial especially when the cardiac function is reduced. The purpose of this study was to retrospectively investigate the operative and long-term results of mitral valve surgery for secondary mitral valve regurgitation with poor cardiac function. Risk factors for long-term mortality were also investigated. Methods Patients with preoperative echocardiographic left ventricular ejection fraction ≤30% who underwent mitral valve surgery due to secondary mitral regurgitation comprised the study group. Cardiac function and valve regurgitation was assessed with echocardiogram using modifiled Simpson’s method and color-flow Doppler. Peri-operative results and long-term survival were investigated. Results Sixty-nine patients (mean age 65.5 years, 58 males) with secondary mitral regurgitation and poor left ventricular function comprised the study group, and their early results were investigated; long-term results were evaluated in 66 cases. There were no operative/in-hospital deaths. Postoperative echocardiograms showed significantly improved mitral regurgitation, from moderate to severe to less than trivial (p<0.001), although poor left ventricular function remained. Actual 1-, 3-, and 5-year survival rates were 90.5%, 76.5%, and 63.4%, respectively. The 1-, 3-, and 5-year re-admission-free rates due to heart failure were 74.6%, 61.6%, and 55.3%, respectively. Patients with clinical frailty scale scores ≥4 had a worse prognosis than patients with clinical frailty scale scores <4 (log-rank p=0.046). Conclusions Open mitral valve surgery could be appropriate for secondary mitral valve regurgitation with poor cardiac function, however, operative indications should be considered carefully in patients with high clinical frailty scale scores.

Background and aim: Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on- or off-pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off-pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off-pump coronary artery bypass-first strategy to all generations since 2008. This study investigated early and long-term results of surgical revascularization for octogenarians by a team with an off-pump-first strategy. Methods: All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age <80 years) and an old group (age >=80 years). Peri-operative results were investigated retrospectively in both groups and long-term results for the old group were assessed. Results: Among the 707 patients, 97% underwent off-pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In-hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow-up of 1318 days, actual 1-, 3-, and 5-year survival rates for octogenarians were 92.1%, 81.2% and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions: An experienced team with an off-pump-first strategy could provide valid therapeutic options for octogenarians.

Background: The benefits of bilateral internal thoracic artery (BITA) grafting during coronary artery bypass grafting in dialysis-dependent end-stage renal disease patients remain unclear. We compared the early and long-term effectiveness of coronary artery bypass using BITA versus single internal thoracic artery (SITA) grafting in this population. Methods: Eighty-nine consecutive patients with dialysis-dependent end-stage renal disease who underwent isolated coronary artery bypass grafting were retrospectively analyzed. Early and long-term results were reviewed, and univariate and multivariate analyses of risk factors for late death and major adverse cardiac events (MACE) was performed. Results: There was no significant difference between the BITA (n = 65) and SITA (n = 24) groups in in-hospital mortality (0% vs. 4.2%, p = 0.27) and the incidence of deep surgical wound infection (4.6% vs. 4.2%, p = 1.00). The overall survival rate in the BITA and SITA groups were 90.2% vs. 82.3%, 64.6% vs. 57.6%, and 51.8% vs. 20.6% at 1, 3, and 5 years, respectively. Overall survival was comparable but was more favorable in the BITA group (p = 0.08). MACE-free rate in the BITA and SITA groups were 96.6% vs. 90.2%, 87.4% vs. 60.6%, and 70.1% vs. 51.8% at 1, 3, and 5 years, respectively. The MACE-free rate was significantly higher in the BITA group (p = 0.04). Conclusions: While BITA grafting did not show a significant survival benefit over SITA grafting, it did not increase surgical complications and improve the MACE-free rate. BITA grafting may be a reasonable surgical strategy in dialysis-dependent patients.