POINT: Efficacy of adding mitral valve restrictive annuloplasty tocoronary artery bypass grafting in patients with moderate ischemicmitral valve regurgitation: A randomized trial

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Abstract

Objective: Surgical management of moderate chronic ischemic mitral valve regurgitation is still debated. Theaim of this study was to evaluate the effect of adding mitral valve repair to coronary artery bypass grafting onclinical outcomes and left ventricular remodeling in patients who underwent coronary artery bypass grafting aloneversus coronary artery bypass grafting plus mitral valve repair in a randomized trial.Methods: Between February 2003 and May 2007, 102 patients were eligible for this study and were randomlyassigned to one of 2 groups by means of card allocation: coronary artery bypass grafting plus mitral valve repair(CABG plus MVR group; 48 patients, 47%) or coronary artery bypass grafting alone (CABG group; 54 patients,53%). The 2 groups were similar regarding demographics, perioperative clinical data, and outcomes. There weredifferences regarding cardiopulmonary bypass (P<.0001) and aortic crossclamp (P<.0001) times. Exercisetests were performed for all survivors to evaluate tolerance to exercise and variability on grade of mitral regurgitationand systolic pulmonary arterial pressure. The study was blinded for physicians and nurses involved inpostoperative care and clinical follow-up. The mean follow-up was 32 18 months.Results: Overall in-hospital mortality was 3% (3 patients). One (1.8%) patient died in the CABG group, and 2(4.1%) patients died in the CABG plus MVR group. Survival rates standard error at 5 years for patients in theCABG and CABG plus MVR groups were 88.8% 3.2% and 93.7% 3.1%, respectively. A significant differencewas found between the 2 groups with regard to mean New York Heart Association class (P<.0001), leftventricular end-diastolic diameter (P<.01), left ventricular end-systolic diameter (P<.01), pulmonary arterialpressure (P<.0001), and left atrial size (P<.01). At follow-up, coronary artery bypass grafting alone was able toreduce mitral regurgitation grade in 40%of patients, whereas in the remaining patients mitral regurgitation graderemained stable or worsened. In the CABG group, among the 17 patients with mild mitral regurgitation and 12patients with moderate mitral regurgitation at rest, 7 (40%) and 9 (75%) patients, respectively, had worsening inmitral regurgitation grade and pulmonary artery pressure during exercise.Conclusions: The efficacy of adding mitral valve repair to coronary artery bypass grafting is well demonstratedby the improvement of New York Heart Association functional class and percentage of left ventricular ejectionfraction and by the decrease of mitral regurgitation grade, left ventricular end-diastolic diameter, left ventricularend-systolic diameter, pulmonary artery pressure, and left atrial size. Moreover, coronary artery bypass graftingalone left more patients with heart failure symptoms at rest and during exercise. Combined coronary artery bypassgrafting and mitral valve repair have no effect on survival at short-term follow-up, and the trends that are evidentwill likely become more significant with time.
Original languageEnglish
Pages (from-to)278-285
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume138
Publication statusPublished - 2009

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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