Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting

Roshanali, Farideh; Shoar, Saeed; Shoar, Nasrin; Naderan, Mohammad; Alaeddini, Farshid; Mandegar, Mohammad Hossein

doi:10.1016/j.jtcvs.2013.12.028

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…With viable hibernating myocardium, revascularization has the potential to improve LV function and reverse LV remodeling and thereby improve MR. Roshanali et al 35 reported that if reversibility of myocardium could be shown by dobutamine stress echocardiogram (DSE), these patients could benefit from CABG alone. However, in their recent study, they found that viability prediction by DSE does not essentially reflect the long-term outcomes in patients receiving isolated CABG for moderate ischemic MR. 36 The largest randomized trial of moderate MR undergoing CABG reported their 1-and 2-year outcomes recently and the addition of MVR/Re to CABG did not result in improvement in symptoms, mortality at 1 year or LVESVi at either 1 or 2 years. 27 There was, however, a higher risk of neurological events and longer hospital stay associated with the addition of MVR/Re and a longer bypass time.…”

Section: Discussionmentioning

confidence: 98%

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Narayanan

Aggarwal

Reddy

et al. 2017

Thorac cardiovasc Surg

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Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature. We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95% confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic. A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel-Haenszel [MH] risk ratio [RR]: 0.96, 95% CI: 0.75-1.24, = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39-1.07, = 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21-2.03, = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95% CI: 0.61-1.32, = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: - 2.50, 95% CI: - 5.21 to - 0.21, = 0.071) and LV ejection fraction (MD: 0.48, 95% CI: - 2.48 to 3.44, = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI: 1.79-5.89, < 0.001) was higher in the CABG only group. Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.

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Section: Discussionmentioning

confidence: 98%

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Narayanan

Aggarwal

Reddy

et al. 2017

Thorac cardiovasc Surg

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Surgical management of moderate ischemic mitral valve regurgitation: Where do we stand?

Fattouch

Castrovinci

Murana

et al. 2014

WJC

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Ischemic mitral regurgitation (IMR) represents a common complication after myocardial infarction. The valve is anatomically normal and the incompetence is the result of papillary muscles displacement and annular dilatation, causing leaflets tethering. Functionally the leaflets present a restricted systolic motion due to tethering forces that displaces the coaptation surface toward the left ventricle apex. The patients present poor left ventricular function at the time of surgery and the severity of the mitral regurgitation increases the risk of mortality. Currently there is general agreement to treat surgically severe IMR nevertheless strong evidences for patient with moderate insufficiency remains poor and proper treatment debated. The most effective surgical approach for the treatment of IMR remains debated. Some authors demonstrated that coronary artery bypass graft (CABG) alone is beneficial in patients with IMR. Conversely, in most patients, moderate IMR will persist or worsen after CABG alone which translate in higher long-term mortality as a function of residual mitral regurgitation severity. A probable reason for this unclear surgical management of functional MR is due to the contemporary suboptimal results of reparative techniques. The standard surgical treatment of chronic IMR is CABG associated with undersized annuloplasty using complete ring. Though, the recurrence of mitral regurgitation remains high (> 30%) because of continous left ventricle remodeling. To get better long term results, in the last decade, several subvalvular procedures in adjunct to mitral anuloplasty have been developed. Among them, surgical papillary muscle relocation represents the most appreciated option capable to restore normal left ventricle geometry. In the next future new preoperative predictors of increased mitral regurgitation recurrence are certainly needed to find an individual time period of treatment in each patient with moderate IMR. Key words: Anatomy; Surgery; Cardiology; Valve; Mitral; Echocardiography Core tip: Moderate ischemic mitral regurgitation should always be considered in patients undergoing other cardiac surgery. Restrictive anuloplasty alone fails as valid treatment because often associated with persistence and high recurrence rate of mitral regurgitation due to continuous ventricular remodeling. Probably more aggressive repair procedures addressing the subvalvular mitral apparatus would help to find more durable results for this complex disease. In the next future new preoperative predictors of increased MR recurrence are certainly needed to find an individual time period of treatment in each patients with moderate ischemic mi- MINIREVIEWSSubmit a

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Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting

Abstract: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.

Cited by 2 publications

References 35 publications

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Surgical management of moderate ischemic mitral valve regurgitation: Where do we stand?

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