Moderate Chronic Ischemic Mitral Regurgitation

Abstract

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data. All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching. Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively). Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.

Elderly Patients with Moderate Chronic Ischemic Mitral Regurgitation: Coronary Artery Bypass Grafting Alone or Concomitant Mitral Annuloplasty?

“…Our previous study supported the concomitant mitral valve procedure instead of CABG alone for the treatment of moderate chronic IMR [13]. However, the subjects of our previous study included not just the elderly but the nonelderly.…”

Changes and predictors of secondary mild mitral regurgitation after coronary artery bypass grafting

“…CABG surgery is an effective common revascularization treatment for severe coronary artery disease to reduce the risk of sudden cardiac death and improve myocardial function [12]. Functional MR is commonly observed after MI and an independent predictor of mortality and cardiovascular morbidity [13]. CABG companied with mitral valve surgery may improve left ventricular performance, reverse left ventricular remodeling and then provide a more durable correction of moderate IMR [14].…”

“…In order to reduce the risk of sudden cardiac death and improve myocardial function, coronary artery bypass grafting (CABG) is an effective revascularization treatment [12], and concomitant mitral valve surgery at the time of CABG is recommended patients with symptoms of severe MR and promotes to eliminate moderate MR [13,14]. However mild MR is often neglected in clinical practice, which has been shown to be associated with mortality in a diabetic population even in the presence of normal ejection fraction [15].…”