Key result
Concomitant mitral valve repair during CABG is linked to ~59% lower mortality in moderate IMR.
Why the study?
The surgical management of moderate ischemic mitral regurgitation in patients undergoing CABG remains controversial, with limited real-world evidence, particularly from Asian populations.
Does concomitant mitral valve repair during coronary artery bypass grafting reduce all-cause mortality in patients with coronary artery disease and moderate ischemic mitral regurgitation?
Cohort (n=650)
Does concomitant mitral valve repair during coronary artery bypass grafting reduce all-cause mortality in patients with coronary artery disease and moderate ischemic mitral regurgitation?
In an Asian real-world cohort of patients with moderate ischemic mitral regurgitation undergoing CABG, concomitant mitral valve repair was associated with lower all-cause mortality, fewer MACCE, and greater echocardiographic improvement, despite increased perioperative morbidity.
Background The surgical management of moderate ischemic mitral regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) remains controversial, with limited real-world evidence, particularly from Asian populations. Purpose To compare long-term clinical outcomes and echocardiographic changes between isolated CABG and CABG with concomitant mitral valve repair (MVr) in patients with coronary artery disease and moderate IMR. Methods We retrospectively analyzed 650 patients with moderate IMR who underwent isolated CABG (n=493) or CABG with MVr (n=157) between August 2009 and April 2024. Inverse probability of treatment weighting was applied to adjust for baseline differences. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, repeat revascularization, repeat mitral valve surgery, and rehospitalization for heart failure. Results During a median follow-up of 36.6 months, CABG with MVr was associated with lower all-cause mortality (multivariable HR, 0.41; 95% CI, 0.22-0.79; weighted log-rank P=0.006) and fewer MACCE (weighted log-rank P=0.001), mainly driven by fewer deaths and rehospitalizations for heart failure. Findings were consistent across sensitivity and subgroup analyses. At echocardiographic follow-up (median, 11.6 months), CABG with MVr showed greater improvement in mitral regurgitation (75.4% vs 50.4%, P<0.001) and a larger reduction in left ventricular end-diastolic diameter (4.0 [0.0, 7.8] vs 3.0 [-1.0, 6.0], P=0.026). CABG with MVr was associated with longer postoperative intubation, longer intensive care unit stay, and an increased risk of acute kidney injury, without increased early mortality. Conclusions In one of the largest Asian real-world cohorts, concomitant MVr during CABG for moderate IMR was associated with lower mortality, fewer MACCE, and greater echocardiographic improvement, but at the expense of increased perioperative morbidity.
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Chen et al. (2026) conducted a cohort in Coronary artery disease and moderate ischemic mitral regurgitation (n=650). CABG with concomitant mitral valve repair (MVr) vs. Isolated CABG was evaluated on All-cause mortality (HR 0.41, 95% CI 0.22-0.79, p=0.006). Concomitant mitral valve repair during CABG for moderate ischemic mitral regurgitation was associated with lower all-cause mortality compared to isolated CABG (HR 0.41; 95% CI 0.22-0.79; P=0.006).
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