Key result
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).
Why the study?
Does adding mitral valve repair to CABG improve peak oxygen consumption in patients with moderate ischemic mitral regurgitation and ejection fraction >30%?
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%?
Absolute Event Rate: 3.3% vs 0.8%
p-value: p=<0.001
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.
Supports adding annuloplasty to CABG for improved functional capacity in moderate ischemic MR; extends RCT evidence on reverse remodeling.
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.
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Chan et al. (2012) conducted an 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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