Key result
Simultaneous mitral ring annuloplasty during coronary artery bypass grafting was associated with a lower rate of hospitalization for heart failure compared to isolated CABG (10.6% vs 27.1%; P=0.02).
Why the study?
Does simultaneous mitral ring annuloplasty and coronary artery bypass grafting improve outcomes in patients with coronary artery disease and chronic ischemic moderate to severe mitral regurgitation compared to isolated coronary artery bypass grafting?
Cohort (n=132)
No
Does simultaneous mitral ring annuloplasty and coronary artery bypass grafting improve outcomes in patients with coronary artery disease and chronic ischemic moderate to severe mitral regurgitation compared to isolated coronary artery bypass grafting?
Absolute Event Rate: 10.6% vs 27.1%
p-value: p=0.02
Adding mitral ring annuloplasty to CABG in patients with moderate to severe ischemic mitral regurgitation reduces heart failure hospitalizations and improves functional class and ejection fraction without increasing early mortality.
Should not change practice pending randomized trials; leaves open whether mitral annuloplasty reduces HF hospitalization.
Objective: To investigate the mid-and long-term outcomes of case-based selective strategy of mitral ring annuloplasty during coronary artery bypass grafting in patients with coronary artery disease accompanied by chronic ischemic mitral regurgitation. Methods: 132 patients who were diagnosed ischemic moderate to severe mitral regurgitation undergoing coronary artery bypass grafting in the same center with the same surgical team were divided into 2 groups and investigated retrospectively. Patients undergoing simultaneous mitral ring annuloplasty and coronary artery bypass grafting were enrolled to group 1 (n=58), patients undergoing isolated coronary artery bypass grafting were enrolled in group 2 (n=74). Results: The mean age of the patients were 65.0 9.4 years and 39 (29.5%) of them were female. Preoperative New York Heart Association (NHYA) class (P=0.0001), atrial fibrillation (P=0.006) and the grade of mitral regurgitation (P=0.0001) were significantly different between the groups. Hospitalization for heart failure was required in 6 (10.6%) patients in group 1 and 19 (27.1%) patients in Group 2 (P=0.02). Hospital mortality and one-month postoperative mortality occurred in 2 (3.4%) patients in Group 1 and in 4 (5.4%) patients in Group 2 (P=0.69). Clinical follow-up was completed with 117 (88.6%) patients. Conclusion: Mitral ring annuloplasty in addition to the coronary artery bypass grafting is associated with improved NYHA functional class, increased ejection fraction, decreased residual mitral regurgitation. Further studies are needed to clarify the role of combined surgery on long-term outcomes. With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed.
No takes yet. Share an insight, caveat, or question.
Şaşkın et al. (2017) conducted a cohort in Coronary artery disease with chronic ischemic mitral regurgitation (n=132). Simultaneous mitral ring annuloplasty and coronary artery bypass grafting vs. Isolated coronary artery bypass grafting was evaluated on Hospitalization for heart failure (p=0.02). Simultaneous mitral ring annuloplasty during coronary artery bypass grafting was associated with a lower rate of hospitalization for heart failure compared to isolated CABG (10.6% vs 27.1%; P=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: