title: Coronary revascularization alone or with mitral valve repair: outcomes in patients with moderate ischemic mitral regurgitation.
abstract: We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr).A total of 83 patients had a reduced left ventricular ejection fraction and moderate mitral regurgitation: 28 patients underwent CABG+MVr, and 55 underwent CABG alone. Changes in mitral regurgitation, functional class, and left ventricular ejection fraction were compared in both groups.The mean follow-up was 5.1 +/- 3.6 years (range, 0.1-15.1 yr). Reduction of 2 mitral-regurgitation grades was found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P < 0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively (P = 0.1), as well as improvements in left ventricular ejection fraction and functional class. One- and 5-year survival rates were similar in the CABG+MVr and CABG-only groups: 96% +/- 3% versus 96% +/- 4%, and 87% +/- 5% versus 81% +/- 8%, respectively (P = NS). Propensity analysis showed similar results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and 47% at late follow-up, respectively.In patients with moderate ischemic mitral regurgitation, either surgical approach led to an improvement in functional class. Early and intermediate-term mortality rates were low with either CABG or CABG+MVr. However, an increased rate of late recurrent mitral regurgitation in the CABG+MVr group was observed.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.forename: Michele A
authors.initials: MA
authors.lastname: DeRobertis
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Kaveh
authors.initials: K
authors.lastname: Zivari
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kass
authors.forename: Sharo
authors.initials: S
authors.lastname: Raissi
authors.forename: Gregory
authors.initials: G
authors.lastname: Fontana
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left