Key result
Adding mitral valve repair to CABG is linked to ~70% lower 4-year mortality.
Why the study?
The impact of mitral valve repair on survival in patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG versus CABG with surgical ventricular reconstruction required evaluation.
Observational (n=867)
Single-blind (echocardiography core laboratory blinded to clinical data)
Randomized to CABG or CABG+SVR; non-randomized surgeon discretion for MVRe
Yes
Answers are grounded in this paper and cite their sources.
May support mitral repair with CABG in ischemic MR; hypothesis-generating subgroup analysis leaves open need for dedicated RCTs.
Background This study examined the impact of mitral valve repair (MVRe) on survival of patients with moderate or severe (≥2+) MR and ischemic cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus CABG+surgical ventricular reconstruction (SVR) in the STICH trial. Methods Among patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on mortality between the two treatment arms was compared. Results Among 867 patients with assessment of baseline MR severity, 211 had moderate or severe MR. After excluding 7 patients who underwent mitral valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe, CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard ratio [HR] 0.30; 95% CI 0.13–0.71). In contrast, the CABG+SVR+MVRe and CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR 0.88; 95% CI 0.46–1.70). MVRe had a more favorable effect on survival in patients undergoing CABG alone compared to CABG+SVR ( p = 0.013). Baseline MR severity was similar between patients that received CABG+MVRe and those that underwent CABG+SVR+MVRe. A larger proportion of patients demonstrated a reduction in MR between 4 and 24 months after CABG+MVRe compared to CABG+SVR+MVRe (50.0% versus 25.0%, p = 0.023). Conclusion In patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG, MVRe appears to have a favorable effect on survival. The addition of SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the long-term reduction of MR with MVRe.
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Tsang et al. (2019) conducted an observational in Ischemic cardiomyopathy with moderate or severe mitral regurgitation (n=867). Coronary artery bypass grafting plus mitral valve repair (CABG+MVRe) vs. Coronary artery bypass grafting (CABG) alone, and CABG plus surgical ventricular reconstruction (SVR) with or without MVRe was evaluated on 4-year all-cause mortality (CABG+MVRe vs CABG alone in moderate or severe MR) (HR 0.30, 95% CI 0.13-0.71, p=0.013 for interaction between MVRe and treatment arms). Mitral valve repair added to CABG lowered 4-year mortality versus CABG alone (16% vs 55%; adjusted HR 0.30, 95% CI 0.13–0.71), an effect attenuated by adding SVR (interaction p=0.013).
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