Restrictive Annuloplasty and Coronary Revascularization in Ischemic Mitral Regurgitation Results in Reverse Left Ventricular Remodeling
Key result
Combined CABG and restrictive annuloplasty in patients with ischemic mitral regurgitation significantly reduced LV end-systolic dimension from 51 to 43 mm (P<0.001) at 2 years.
Why the study?
Does combined CABG and restrictive annuloplasty improve left ventricular reverse remodeling and clinical outcomes in patients with ischemic cardiomyopathy and severe mitral regurgitation?
Population
51 patients with ischemic LV dysfunction and severe mitral regurgitation
Design
Cohort
Follow-up
2 years
Authors
Discussion
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Member takes
Implication
Supports LV reverse remodeling with combined CABG-annuloplasty in ischemic MR; hypothesis-generating and should not yet change practice pending RCTs.
Key Points
- To evaluate the impact of combined coronary artery bypass grafting and restrictive annuloplasty on left ventricular reverse remodeling and clinical outcomes in patients with ischemic cardiomyopathy and severe mitral regurgitation.
- Followed 51 patients with ischemic left ventricular dysfunction (mean ejection fraction 31±8%) and severe mitral regurgitation (grade 3 to 4+) undergoing CABG and restrictive annuloplasty with ring downsizing by two sizes (mean size 28±2).
- Conducted serial transthoracic echocardiography preoperatively, within 3 months, and at 1.5 years post-surgery to evaluate regurgitation and cardiac dimensions, alongside a 2-year clinical follow-up.
- Operative mortality was 5.6%, 2-year survival reached 84%, and NYHA functional class improved significantly from 3.4±0.8 to 1.3±0.4 (P < 0.01), with all surviving patients in class I or II.
- Left ventricular end-systolic dimensions decreased from 51±10 to 43±12 mm (P < 0.001), end-diastolic dimensions decreased from 64±8 to 58±11 mm (P < 0.001), and left atrial dimensions decreased from 53±8 to 47±7 mm (P < 0.001).
- Mitral regurgitation remained absent or minimal (grade 1+) across all patients at 2-year follow-up, with only one patient requiring reoperation for recurrent regurgitation.
Study Design
Type
Observational (n=51)
Structured PICO
Does combined CABG and restrictive annuloplasty improve left ventricular reverse remodeling and clinical outcomes in patients with ischemic cardiomyopathy and severe mitral regurgitation?
P
Population
51 patients with ischemic LV dysfunction (LV ejection fraction 31+/-8%) and severe mitral regurgitation (grade 3 to 4+)
I
Intervention
Combined coronary artery bypass grafting (CABG) and restrictive annuloplasty with stringent downsizing of the mitral annulus (by 2 sizes, Physio-ring, mean size 28+/-2)
O
Outcome
Left ventricular reverse remodeling (LV end-systolic and end-diastolic dimensions), left atrial dimension, mitral regurgitation severity, and clinical outcomes (NYHA class, survival, events) assessed by serial echocardiography and clinical follow-up at 2 yearssurrogate
Main Result
p-value: p=<0.001
Combined restrictive annuloplasty and CABG in patients with ischemic cardiomyopathy and severe mitral regurgitation leads to significant left ventricular reverse remodeling and symptomatic improvement at 2 years.
Cite This Study
Bax et al. (2004) conducted an observational in Ischemic cardiomyopathy with severe mitral regurgitation (n=51). CABG and restrictive annuloplasty was evaluated on LV end-systolic dimension (mm) (p=<0.001). Combined CABG and restrictive annuloplasty in patients with ischemic mitral regurgitation significantly reduced LV end-systolic dimension from 51 to 43 mm (P<0.001) at 2 years.