Adding mitral annuloplasty to CABG in patients with moderate ischemic MR significantly improved peak oxygen consumption at 1 year compared to CABG alone (3.3 vs 0.8 mL/kg/min; P<0.001).
RCT (n=73)
Does adding mitral valve repair to CABG improve peak oxygen consumption in patients with moderate ischemic mitral regurgitation and ejection fraction >30%?
Adding mitral annuloplasty to CABG in patients with moderate ischemic mitral regurgitation improves functional capacity and left ventricular reverse remodeling at 1 year, though it increases operation time and hospital stay.
Absolute Event Rate: 3.3% vs 0.8%
p-value: p=<0.001
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. Methods and 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. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00413998.
Chan et al. (Thu,) conducted a rct in Moderate functional ischemic mitral regurgitation (n=73). CABG plus mitral valve repair (annuloplasty) vs. CABG only was evaluated on Improvement in peak oxygen consumption (p=<0.001). Adding mitral annuloplasty to CABG in patients with moderate ischemic MR significantly improved peak oxygen consumption at 1 year compared to CABG alone (3.3 vs 0.8 mL/kg/min; P<0.001).
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