title: Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation.
abstract: OBJECTIVE
  The aim of this work was to determine whether mitral valve (MV) annuloplasty benefits patients with moderate/severe (3+/4+) functional ischemic mitral regurgitation (MR) who undergo coronary artery bypass grafting (CABG).
  
  
  BACKGROUND
  Mitral regurgitation is a strong predictor of poor outcomes in patients with ischemic cardiomyopathy; whether correcting it at the time of CABG improves outcomes is less certain.
  
  
  METHODS
  From 1991 to 2003, 390 patients with 3+/4+ ischemic MR had CABG with (n = 290) or without (n = 100) MV annuloplasty. Groups were propensity-matched using demographics, extent of coronary disease, regional wall motion, and quantitative electrocardiography. Survival, echocardiographic severity of MR, and New York Heart Association (NYHA) functional class were compared.
  
  
  RESULTS
  One-, 5-, and 10-year survival was 88%, 75%, and 47% after CABG alone and 92%, 74%, and 39% after CABG + MV annuloplasty (p = 0.6). Mortality was increased in patients with severe lateral wall motion abnormalities (p = 0.05), ST-segment elevation in lateral leads (p < 0.004), and higher QRS voltage sum (p < 0.0001). Patients undergoing CABG alone were more likely to have 3+/4+ postoperative MR than those undergoing CABG + MV annuloplasty (48% vs. 12% at 1 year, p < 0.0001). The NYHA functional class substantially improved in both groups (p < 0.001) and remained improved; at 5 years, 23% of patients having CABG + mitral annuloplasty and 25% having CABG alone were in NYHA functional class III/IV.
  
  
  CONCLUSIONS
  Although CABG + MV annuloplasty reduces postoperative MR and improves early symptoms compared with CABG alone, it does not improve long-term functional status or survival in patients with severe functional ischemic MR. The MV annuloplasty in this setting, without addressing fundamental ventricular pathology, is insufficient to improve long-term clinical outcomes.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. mihaljt@ccf.org
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Buu-Khanh
authors.initials: BK
authors.lastname: Lam
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Masami
authors.initials: M
authors.lastname: Takagaki
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods; D015996:Survival Rate