Home > General Cardiology, Journal Club, Valvular heart disease > Journal Club 4 February 2015

Journal Club 4 February 2015

Paper

Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Presenter

AL

Summary

Background

Ischemic mitral regurgitation is associated with increased mortality and morbidity.
For surgical patients with moderate regurgitation, the benefits of adding mitralvalve
repair to coronary-artery bypass grafting (CABG) are uncertain.

Methods

We randomly assigned 301 patients with moderate ischemic mitral regurgitation to
CABG alone or CABG plus mitral-valve repair (combined procedure). The primary end
point was the left ventricular end-systolic volume index (LVESVI), a measure of left
ventricular remodeling, at 1 year. This end point was assessed with the use of a
Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank.

Results

At 1 year, the mean LVESVI among surviving patients was 46.1±22.4 ml per square
meter of body-surface area in the CABG-alone group and 49.6±31.5 ml per square meter
in the combined-procedure group (mean change from baseline, −9.4 and −9.3 ml per
square meter, respectively). The rate of death was 6.7% in the combined-procedure
group and 7.3% in the CABG-alone group (hazard ratio with mitral-valve repair, 0.90;
95% confidence interval, 0.38 to 2.12; P = 0.81). The rank-based assessment of LVESVI
at 1 year (incorporating deaths) showed no significant between-group difference
(z score, 0.50; P = 0.61). The addition of mitral-valve repair was associated with a longer
bypass time (P<0.001), a longer hospital stay after surgery (P = 0.002), and more neurologic
events (P = 0.03). Moderate or severe mitral regurgitation was less common in the
combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%, P<0.001).
There were no significant between-group differences in major adverse cardiac or cerebrovascular
events, deaths, readmissions, functional status, or quality of life at 1 year.

Conclusions

In patients with moderate ischemic mitral regurgitation, the addition of mitral-valve
repair to CABG did not result in a higher degree of left ventricular reverse remodeling.
Mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral
regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did
not show a clinically meaningful advantage of adding mitral-valve repair to CABG.
Longer-term follow-up may determine whether the lower prevalence of mitral regurgitation
translates into a net clinical benefit.

Supplementary Material

Editorial

Advertisements
  1. No comments yet.
  1. No trackbacks yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: