Key result
Adding mitral surgery to revascularization increases hospital mortality up to ~14% despite better long-term survival.
Why the study?
Treatment of ischemic mitral regurgitation in patients requiring myocardial revascularization remains debatable regarding the optimal surgical approach.
Does mitral valve repair or replacement combined with revascularization improve survival compared to revascularization alone in patients with ischemic mitral regurgitation?
Cohort (n=43)
No
Does mitral valve repair or replacement combined with revascularization improve survival compared to revascularization alone in patients with ischemic mitral regurgitation?
Absolute Event Rate: 14.2% vs 0%
In patients with ischemic mitral regurgitation, adding mitral valve repair or replacement to revascularization may increase short-term surgical mortality but potentially improves mid-term survival compared to revascularization alone.
Observational series suggests revascularization alone may lower early mortality in severe ischemic MR; leaves open optimal strategy for randomized confirmation.
INTRODUCTION: Treatment of ischemic mitral regurgitation in patients that require revascularization of myocardium is still debatable. OBJECTIVE: The aim of this study was to compare three surgical approaches: valve repair and revascularization; valve replacement and revascularization, and revascularization alone. METHODS: In 2006 and 2007 at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, 1,040 patients with coronary disease underwent surgery. Forty-three patients (4.3%) had also mitral insufficiency 3-4+. The patients were examined clinically, echocardiographically and haemodynamically. In group I there were 14 (32.3%) patients, in group II 16 (37.2%) patients and in group III 3 (30.5%) patients. Ninety-three per cent of patients were classified as New York Heart Association (NYHA) class III and IV, and three (7%) patients had congestive heart weakness with ejection fraction < or =30%. The decision as to surgical procedure was made by the surgeon. Postoperatively, patients were checked clinically and echocardiographically after 3, 6 and 12 months. The follow-up period was approximately 15 months (8-20). RESULTS: Hospital mortality for the whole group was 6.9% (3 patients). In group I mortality was 14.2% (2 patients), in group II 6.25% and in group III there was no mortality. Long term results, up to 15 months, showed 100% survival in groups I and II, and in group III one patient died (7.7%). CONCLUSION: Short term results upto 30 days were best in group III, but longer term results were better in groups I and II.
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Vranes et al. (2010) conducted a cohort in Ischemic mitral regurgitation (n=43). Valve repair or replacement plus revascularization vs. Revascularization alone was evaluated on Hospital mortality. Valve repair and replacement plus revascularization had higher hospital mortality (14.2% and 6.25%) than revascularization alone (0%), but showed better long-term survival up to 15 months.
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