For ischemic mitral regurgitation, less surgery yields comparable results

Image: PD 

1. Patients who underwent coronary artery bypass graft (CABG) for moderate functional ischemic mitral regurgitation (MR) had similar improvement to those that received CABG plus downsizing annuloplasty.

2. Although CABG plus annuloplasty initially showed greater improvement in mitral regurgitation than CABG alone, outcomes converged over time. 

Evidence Rating Level: 3 (Average) 

Study Rundown: Mitral regurgitation (MR) is often seen in the context of ischemic cardiomyopathy.  Studies have shown conflicting results regarding the benefit of adding mitral valve annuloplasty to CABG for moderate functional ischemic MR. While some surgeons believe CABG alone is adequate, others believe adjunct annuloplasty of the mitral valve ring is necesary for definitive treatment of the valvular regurgitation.  Although a recent meta-analysis found that CABG plus annuloplasty provides greater improvement in New York Heart Association (NYHA) class and degree of MR, this study found no significant differences in NYHA class or MR grade. Although limited by small sample size and length of follow-up time, this study rightfully questions whether the risk introduced by adding annuloplasty to CABG is justified by its improvement of outcomes.

Click to read the study in JTCS

Relevant Reading: 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

In-Depth [randomized controlled trial]: 31 patients with grade 2+ functional ischemic mitral regurgitation were randomized to coronary artery bypass graft (CABG) alone or CABG plus ring annuloplasty. Transesphageal echocardiography assessed mitral regurgitation grade intraoperatively, and serial transthoracic echocardiographic studies were performed at 3 and 12 months post-operatively. At 3 months patients filled out quality of life questionnaires and completed a six-minute walk test. While CABG plus annuloplasty resulted in significantly greater correction of mitral regurgitation intraoperatively, the grade worsened markedly and lost statistical significance compared to CABG alone by 3 months as well as at 12 months. At 12 months, no statistically significant differences were found for left ventricular dimensions, NYHA class, quality of life, or six-minute walk test performance between the two groups.

By Gina Siddiqui and Chaz Carrier

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