Key result
Adding mitral valve repair to coronary artery bypass grafting improved the degree of mitral regurgitation (93% vs 73%; P<0.0001) and NYHA functional class compared to bypass grafting alone.
Why the study?
The best surgical option for moderate ischemic mitral regurgitation—coronary artery bypass grafting alone versus adding mitral repair—remained unclear.
Does combining mitral valve repair with CABG improve NYHA class and degree of MR in patients with moderate ischemic mitral regurgitation compared to CABG alone?
RCT (n=60)
randomized
Does combining mitral valve repair with CABG improve NYHA class and degree of MR in patients with moderate ischemic mitral regurgitation compared to CABG alone?
Adding mitral valve repair to CABG in patients with moderate ischemic mitral regurgitation significantly improves the degree of MR and NYHA functional class without increasing mortality, despite longer bypass and cross-clamp times.
Answers are grounded in this paper and cite their sources.
May support combined repair in moderate ischemic MR; leaves open confirmation in larger trials before practice change.
BACKGROUND: This is a prospective randomized-controlled study done to evaluate the best surgical option for moderate ischemic mitral regurgitation through either coronary artery bypass grafting only or by performing additional mitral repair. METHODS: Over a nine-month period, 60 patients with ischemic heart disease associated with moderate ischemic mitral regurgitation were equally divided into two groups. Group 1 included 30 patients who had coronary artery bypass grafting with mitral valve repair; Group 2 included 30 patients who had only coronary artery bypass grafting. RESULTS: There were no significant differences between the study groups, regarding operative data, apart from the cardiopulmonary bypass time and aortic cross-clamp time, which were significantly longer in group 1 (P < 0.001). Only one patient died in group 1 due to severe myocardial dysfunction. During the follow up, the NYHA class improved in group 1, from 2.7 to 1.35 (P < 0.004), compared with group 2, where the NYHA class improved from 2.6 to 1.72 (P = 0.07). The degree of MR improved in 28 patients (93%) in group 1 and 22 patients (73%) in group 2 (P < 0.0001). CONCLUSION: The study revealed many advantages of adding mitral repair to surgical revascularization in patients with moderate ischemic mitral regurgitation, with improvement in the degree of MR and NYHA functional class. On the other hand there were no significant differences between the groups, regarding the postoperative course and incidence of mortality.
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Khallaf et al. (2020) conducted an RCT in Moderate ischemic mitral regurgitation (n=60). Coronary artery bypass grafting with mitral valve repair vs. Coronary artery bypass grafting only was evaluated on Improvement in the degree of mitral regurgitation (p=<0.0001). Adding mitral valve repair to coronary artery bypass grafting improved the degree of mitral regurgitation (93% vs 73%; P<0.0001) and NYHA functional class compared to bypass grafting alone.
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