Key result
Concomitant mitral valve repair with CABG is linked to ~2-fold higher operative mortality vs. CABG alone.
Why the study?
In patients with mitral regurgitation and advanced left ventricular dysfunction, the benefit of additional mitral valve repair at the time of coronary artery bypass graft surgery was unclear.
Cohort (n=298)
Absolute Event Rate: 10.8% vs 5.1%
p-value: p=<0.05
Concomitant mitral repair during CABG should not yet change practice; observational data leave open selection bias and need for RCTs.
Objectives: In patients with mitral regurgitation (MR) and advanced left ventricular (LV) dysfunction, it is not clear whether additional mitral valve repair (MVR, replacement or reconstruction) at the time of coronary artery bypass graft surgery is beneficial. Methods: A total of 298 consecutive patients with mild, moderate or severe ischemic MR, as determined by preoperative echocardiography, underwent CABG with concomitant MVR (group M, n=102) or CABG only (group C, n=196) between 2003 and 4/2008. The groups were comparable regarding perioperative parameters, such as age, gender, NYHA-class, ejection fraction (EF) and number of bypass grafts. With multivariate logistic regression analysis we wanted to find out predictors of operative mortality. Results: In group M there were more patients with severe MR and the operative mortality was significantly higher (10.8% vs. 5.1% in group C, p<0.05). Among patients with severe MR, MR was improved in 95% of the patients of group M and in only 64% of patients with CABG only. In patients with mild or moderate MR, improvement rates of both groups were comparable (M: 74%, C:69%, n.s.). Postoperatively, LVEF increased in both groups (M: preop.: 31.3±8.5 to postop. 36.4±11.2%; C: 29.9±6.1 to 33.3±8.1%, p>0.05). Preoperative predictors for operative mortality were renal insufficiency, older age and NYHA class III and IV. Conclusion: To reduce ischemic MR, CABG alone is a preferable treatment for patients with mild or moderate MR and high operative risk factors, such as preoperative renal insufficiency, older age and higher NYHA class.
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Boeken et al. (2009) conducted a cohort in Ischemic mitral regurgitation (n=298). Concomitant mitral valve repair (MVR) vs. CABG only was evaluated on Operative mortality (p=<0.05). Concomitant mitral valve repair during CABG was associated with significantly higher operative mortality compared to CABG alone (10.8% vs. 5.1%, p<0.05).