title: Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial.
abstract: BACKGROUND
  The role of mitral valve repair (MVR) during coronary artery bypass grafting (CABG) in patients with moderate ischemic mitral regurgitation (MR) is uncertain. We conducted a randomized, controlled trial to determine whether repairing the mitral valve during CABG may improve functional capacity and left ventricular reverse remodeling compared with CABG alone.
  
  
  RESULTS
  Seventy-three patients referred for CABG with moderate ischemic MR and an ejection fraction >30% were randomized to receive CABG plus MVR (34 patients) or CABG only (39 patients). The study was stopped early after review of interim data. At 1 year, there was a greater improvement in the primary end point of peak oxygen consumption in the CABG plus MVR group compared with the CABG group (3.3 mL/kg/min versus 0.8 mL/kg/min; P<0.001). There was also a greater improvement in the secondary end points in the CABG plus MVR group compared with the CABG group: left ventricular end-systolic volume index, MR volume, and plasma B-type natriuretic peptide reduction of 22.2 mL/m(2), 28.2 mL/beat, and 557.4 pg/mL, respectively versus 4.4 mL/m(2) (P=0.002), 9.2 mL/beat (P=0.001), and 394.7 pg/mL (P=0.003), respectively. Operation duration, blood transfusion, intubation duration, and hospital stay duration were greater in the CABG plus MVR group. Deaths at 30 days and 1 year were similar in both groups: 3% and 9%, respectively in the CABG plus MVR group, versus 3% (P=1.00) and 5% (P=0.66), respectively in the CABG group.
  
  
  CONCLUSIONS
  Adding mitral annuloplasty to CABG in patients with moderate ischemic MR may improve functional capacity, left ventricular reverse remodeling, MR severity, and B-type natriuretic peptide levels, compared with CABG alone. The impact of these benefits on longer term clinical outcomes remains to be defined.
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, Royal Brompton Hospital, Sydney Street, London, United Kingdom. KMJChan@Live.co.uk
authors.forename: K M John
authors.initials: KM
authors.lastname: Chan
authors.forename: Prakash P
authors.initials: PP
authors.lastname: Punjabi
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Riccardo
authors.initials: R
authors.lastname: Wage
authors.forename: Karen
authors.initials: K
authors.lastname: Symmonds
authors.forename: Isabelle
authors.initials: I
authors.lastname: Roussin
authors.forename: Shelley
authors.initials: S
authors.lastname: Rahman-Haley
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kilner
authors.forename: Gilles D
authors.initials: GD
authors.lastname: Dreyfus
authors.forename: John R
authors.initials: JR
authors.lastname: Pepper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome