title: Off pump coronary artery bypass versus mitral annuloplasty in moderate ischemic mitral regurgitation.
abstract: OBJECTIVE
  To compare the outcomes of isolated off-pump coronary artery bypass grafting (OPCAB) to those of mitral annuloplasty (MAP) with revascularization in patients with moderate ischemic mitral regurgitation (MR).
  
  
  METHODS
  Between April 2001 and December 2009, 140 patients with moderate ischemic MR who underwent isolated OPCAB (OPCAB group, n = 77) or MAP with revascularization (MAP group, n = 63) were analyzed.
  
  
  RESULTS
  Freedom from cardiac-related death at eight years was similar between groups (78.4 ± 5.5%, the OPCAB group versus 81.5 ± 5.9%, the MAP group, p = 0.297). In patients with left ventricular ejection fraction (LVEF) >40%, the MAP group were similar to the OPCAB group in freedom from recurrent MR at eight years (85.7± 10.0% versus 84.9 ± 8.3%, p = 0.738), but a significant difference was found in patients with LVEF ≤40% (93.5± 4.5%, the MAP group versus 36.9 ± 18.4%, the OPCAB group, p = 0.013). On multivariate analysis, emergency operation and low LVEF were predictive of recurrent MR.
  
  
  CONCLUSIONS
  Concomitant MAP was more effective against recurrent MR than was OPCAB alone, in patients with LVEF ≤40%. We suggest that MAP should be considered in moderate ischemic MR with low LVEF.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Jeong
authors.forename: Hae Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004630:Emergencies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left