title: Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial.
abstract: BACKGROUND
  Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown.
  
  
  RESULTS
  Patients with ejection fraction ≤35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22-0.77; P=0.006).
  
  
  CONCLUSIONS
  Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
authors.affiliation: Medical University of Silesia, Katowice, Poland. mdeja@sum.edu.pl
authors.forename: Marek A
authors.initials: MA
authors.lastname: Deja
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sun
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.forename: Michal
authors.initials: M
authors.lastname: Krejca
authors.forename: Anil R
authors.initials: AR
authors.lastname: Jain
authors.forename: Yeow
authors.initials: Y
authors.lastname: Leng Chua
authors.forename: Richard
authors.initials: R
authors.lastname: Daly
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mokrzycki
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Robert
authors.initials: R
authors.lastname: Michler
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wróbel
authors.forename: Andre
authors.initials: A
authors.lastname: Lamy
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000401:mortality* / Q000503:physiopathology; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology