Key result
Combined CABG and mitral valve surgery for moderate ischemic mitral regurgitation reduced IMR grade more effectively than CABG alone (0.6 vs 1.2; P=0.039), with no significant difference in survival.
Why the study?
Does combined CABG and mitral valve surgery improve IMR grade, NYHA class, or survival compared to CABG alone in patients with moderate ischemic mitral regurgitation?
Observational (n=42)
No
Does combined CABG and mitral valve surgery improve IMR grade, NYHA class, or survival compared to CABG alone in patients with moderate ischemic mitral regurgitation?
In patients with moderate ischemic mitral regurgitation, adding mitral valve surgery to CABG improves regurgitation severity but does not significantly improve survival or functional status compared to CABG alone.
Answers are grounded in this paper and cite their sources.
Combined CABG+MV may reduce IMR grade more than CABG alone; leaves open survival or symptomatic benefit in moderate IMR.
BACKGROUND: Ischemic mitral regurgitation (IMR) is a frequent complication of coronary artery heart disease and is associated with increased mortality. Controversies exists whether patients with moderate IMR may benefit from a combined procedure with coronary artery bypass grafting (CABG) and treatment of mitral regurgitation. METHODS: 451 patients with moderate IMR (grade 2) receiving either CABG alone (CABG only) or additional mitral valve repair or replacement (CABG+MV) were included in this observational single-centre study. Patients were matched according to the number of bypass grafts, preoperative NYHA functional class and age. In total, 42 patients (21 CABG only, 21 CABG+MV) were analysed. RESULTS: The mean follow-up was 4.3±1.9 years. CABG alone reduced the IMR grade to 1.2±0.5, whereas the combined procedure resulted in a decrease to 0.6±0.7 (P=0.039). NYHA functional class was reduced from grade 2.8±0.6 to 1.6±0.5 (CABG only) and 2.0±1.1 (CABG+MV, P=0.55). Three- and five-year survival rates were 71% and 53% in the CABG only group compared to 60% both after 3 and 5 years in the CABG+MV group (P=0.89). CONCLUSIONS: In this observational study, combined CABG and surgical treatment of moderate IMR was associated with a more effective reduction of IMR than CABG alone. No statistically significant differences in survival or NYHA functional class were observed. Further studies will need to investigate the value of additional mitral valve surgery in moderate IMR.
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Rilinger et al. (2018) conducted an observational in Moderate ischemic mitral regurgitation (n=42). Combined CABG and mitral valve surgery vs. CABG alone was evaluated on IMR grade at follow-up (p=0.039). Combined CABG and mitral valve surgery for moderate ischemic mitral regurgitation reduced IMR grade more effectively than CABG alone (0.6 vs 1.2; P=0.039), with no significant difference in survival.
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