Key result
Concomitant restrictive mitral annuloplasty during CABG showed no difference in reverse left ventricular remodeling at 1 year compared to CABG alone, despite increased perioperative morbidity.
Why the study?
Does concomitant restrictive mitral annuloplasty improve reverse left ventricular remodeling and clinical outcomes compared to CABG alone in patients with moderate ischemic mitral regurgitation undergoing CABG?
Does concomitant restrictive mitral annuloplasty improve reverse left ventricular remodeling and clinical outcomes compared to CABG alone in patients with moderate ischemic mitral regurgitation undergoing CABG?
There is currently insufficient evidence to support the routine addition of mitral valve repair to CABG in patients with moderate ischemic mitral regurgitation.
CABG alone may suffice for moderate IMR to minimize complications; confirms no 1-year reverse LV remodeling benefit from adding annuloplasty.
PURPOSE OF REVIEW: Moderate ischemic mitral regurgitation (IMR) is a common finding in patients undergoing coronary artery bypass grafting (CABG). In this review, we summarize the current evidence on the optimal management of this condition. RECENT FINDINGS: In recent years, several randomized clinical trials have assessed the impact of concomitant restrictive mitral annuloplasty at the time of CABG on reverse left ventricular remodeling, IMR reduction and clinical outcomes. SUMMARY: Surgical revascularization alone is a conservative strategy that reduces IMR in a significant proportion of patients. Concomitant restrictive annuloplasty provides better relief of mitral regurgitation in the immediate postoperative period, at the cost of increased perioperative morbidity. The only major randomized trial on the issue of moderate IMR published to date showed no difference in reverse left ventricular remodeling at 1 year between these two approaches. There are insufficient data in the literature to support the routine addition of mitral valve repair to CABG in patients with moderate IMR.
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Mazine et al. (2015) conducted a review in Moderate ischemic mitral regurgitation. Concomitant restrictive mitral annuloplasty vs. Surgical revascularization alone was evaluated on Reverse left ventricular remodeling, IMR reduction, and clinical outcomes. Concomitant restrictive mitral annuloplasty during CABG showed no difference in reverse left ventricular remodeling at 1 year compared to CABG alone, despite increased perioperative morbidity.
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