Ischemic mitral regurgitation

Elmistekawy, Elsayed; Mesana, Thierry; Chan, Vincent

doi:10.1097/hco.0b013e3283654725

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…The most common initial insult in patients with chronic IMR is remodeling of the LV following ischemia ( 7 ). Once IMR occurs, it progresses as changes in LV size and shape, which results in worsening cardiac function ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Ischemic mitral regurgitation (IMR) is a common mechanical complication in patients with CAD, associated with poor prognosis ( 7 ). Nowadays, mitral valve surgery and concomitant CABG represent the most effective strategy for the treatment of severe symptomatic IMR ( 7 , 8 ). However, in patients with mild to moderate IMR, mitral valve repair or replacement surgery at the time of CABG may not contribute to better survival or left ventricular (LV) reverse remodeling ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, in patients with mild to moderate IMR, mitral valve repair or replacement surgery at the time of CABG may not contribute to better survival or left ventricular (LV) reverse remodeling ( 9 – 11 ). These patients also benefitted from revascularization therapy evolving percutaneous therapies; however, there is no consensus on the accurate revascularization procedure ( 7 ). Therefore, the outcomes of CABG and PCI for patients with no to moderate IMR of different severities are not well-elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Real-World Outcomes of Revascularization Strategies in Patients With Left Ventricular Dysfunction and Three-Vessel Coronary Disease Stratified by Mitral Regurgitation

Fan

Lee

et al. 2021

Front. Cardiovasc. Med.

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Aims: Limited information exists regarding optimal revascularization options for patients with triple-vessel coronary artery disease (TVD), heart failure (HF), and different degrees of mitral regurgitation (MR). Thus, we aimed to compare the effect of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) surgery in the indicated patients.Methods and Results: In the real-world prospective study, 1190 patients with multi-vessel disease and decreased left ventricular systolic function but without severe MR, who underwent PCI or CABG, were enrolled and followed-up for 4.7 ± 1.8 years. The primary endpoint was a composite of cardiovascular death and HF hospitalization. Secondary endpoints were the individual components of the primary outcome. Risk of the primary endpoint was higher in the PCI than in the CABG group (HR = 1.38, 95%CI: 1.14–1.67, and P < 0.01), particularly in patients with moderate MR (HR = 1.85, 95%CI: 1.35–2.55, and P < 0.01). In patients with no-mild MR, the risk of the primary endpoint did not differ significantly between PCI and CABG (P = 0.09). Treatment with PCI was associated with an increased risk for cardiovascular death and HF hospitalization in the moderate MR cohort, while PCI was comparable to CABG in the no-mild MR cohort.Conclusions: In this real-world study, for patients with HF and TVD, CABG was related to lower adverse outcome rates compared to PCI. Assessment of MR can aid in selecting optimal revascularization therapies and in risk stratification.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Real-World Outcomes of Revascularization Strategies in Patients With Left Ventricular Dysfunction and Three-Vessel Coronary Disease Stratified by Mitral Regurgitation

Fan

Lee

et al. 2021

Front. Cardiovasc. Med.

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Impact of different annuloplasty rings on geometry of the mitral annulus with fibroelastic deficiency: the significance of aorto–mitral angle

Wei

Zhang

et al. 2018

Int J Cardiovasc Imaging

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We sought to investigate the impact of full annuloplasty rings versus C-shape bands on mitral annular geometry in the presence of fibroelastic deficiency (FED), as assessed by intraoperative three-dimensional transesophageal echocardiography (3DTEE). We retrospectively selected 65 patients who underwent mitral valve repair for severe mitral regurgitation caused by FED using full rings (the Ring group, n = 30) and C-shape bands (the Band group, n = 35). 71 controls without valvular heart disease were also included. Thorough 3DTEE inspections were performed for the entire cohort to measure morphological parameters of mitral annulus before and after surgery. Mid-term repair durability and left atrial diameter were followed up. The preoperative 3DTEE parameters, including annular diameters, area, height and aorto-mitral angle, were significantly larger in the FED groups than normal, and were comparable between two groups using different annuloplasty devices. After repair, the anterior-posterior diameter, annulus circumference and area were significantly larger in the Band group than in the Ring group. The aorto-mitral angle became comparable with normal value in the Ring group (p = 0.728), but not in the Band group (p = 0.011). Follow-up echocardiographic data showed a significant correlation between postoperative aorto-mitral angle and reduced left atrial diameter at 50.3 months after surgery (r = 0.63; p < 0.001). In conclusion, compared with C-shape bands, full rings may impose less narrowing on aorto-mitral angle, which correlates well with mid-term left atrial reverse remodeling.

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