Document Detail


Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation.
MedLine Citation:
PMID:  16820626     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: For patients with ischemic mitral regurgitation (MR), it is not clear whether adjunctive mitral valve (MV) repair at the time of coronary artery bypass graft surgery (CABG) is beneficial. We sought to test the hypothesis that MV repair with CABG is superior to CABG alone in improving MR without increasing operative or long-term mortality. METHODS AND RESULTS: A total of 107 consecutive patients with moderate or severe ischemic MR, as determined by preoperative echocardiography, underwent CABG with concomitant MV repair (repair group, n=50) or CABG only (CABG group, n=57). Degree of MR was graded as none, mild, moderate, or severe by the proximal isovelocity surface area method. The groups were similar with respect to age, gender, baseline New York Heart Association class, ejection fraction, and number of bypass grafts. The repair group had a higher percentage of patients with atrial fibrillation or severe MR than the CABG group. The operative mortality was significantly higher for the repair group (12%) than the CABG group (2%), whereas the 5-year actuarial survival rate of the 2 groups was similar (88%+/-5% versus 87%+/-6%). On multivariate logistic regression analysis, older age, higher New York Heart Association class, and atrial fibrillation were independent predictors of operative mortality (P<0.05). Among patients with severe MR, ischemic MR was improved in all patients of the repair group and in 67% of patients in the CABG group (P<0.001), whereas improvement rates in patients with moderate MR were similar in the 2 groups (75% versus 67%, P=NS). CONCLUSIONS: Although MV repair appears to be more effective at reducing ischemic functional MR, CABG alone may be a preferable treatment option for patients with moderate MR and high operative risk factors such as old age or atrial fibrillation.
Authors:
Duk-Hyun Kang; Mi-Jeong Kim; Soo-Jin Kang; Jong-Min Song; Hyun Song; Myeong-Ki Hong; Kee-Joon Choi; Jae-Kwan Song; Jae-Won Lee
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  114     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-05     Completed Date:  2006-08-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I499-503     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Ulsan, Asan Medical Center, Songpa-ku Poongnap-dong 388-1, Seoul 138-736, Korea. dhkang@amc.seoul.kr
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / complications,  epidemiology
Comorbidity
Coronary Artery Bypass* / statistics & numerical data
Diabetes Mellitus / epidemiology
Female
Follow-Up Studies
Humans
Internal Mammary-Coronary Artery Anastomosis / statistics & numerical data
Life Tables
Male
Middle Aged
Mitral Valve / surgery*
Mitral Valve Insufficiency / epidemiology,  etiology,  surgery*
Myocardial Ischemia / complications*,  epidemiology,  surgery
Postoperative Complications / mortality
Proportional Hazards Models
Risk Factors
Severity of Illness Index
Statistics, Nonparametric
Stroke Volume
Survival Analysis
Ventricular Remodeling

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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