Document Detail


Surgical treatment of moderate ischemic mitral regurgitation.
MedLine Citation:
PMID:  25405390     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Ischemic mitral regurgitation is associated with increased mortality and morbidity. For surgical patients with moderate regurgitation, the benefits of adding mitral-valve 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. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.).
Authors:
Peter K Smith; John D Puskas; Deborah D Ascheim; Pierre Voisine; Annetine C Gelijns; Alan J Moskowitz; Judy W Hung; Michael K Parides; Gorav Ailawadi; Louis P Perrault; Michael A Acker; Michael Argenziano; Vinod Thourani; James S Gammie; Marissa A Miller; Pierre Pagé; Jessica R Overbey; Emilia Bagiella; François Dagenais; Eugene H Blackstone; Irving L Kron; Daniel J Goldstein; Eric A Rose; Ellen G Moquete; Neal Jeffries; Timothy J Gardner; Patrick T O'Gara; John H Alexander; Robert E Michler;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2014-11-18
Journal Detail:
Title:  The New England journal of medicine     Volume:  371     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2014 Dec 
Date Detail:
Created Date:  2014-12-04     Completed Date:  -     Revised Date:  2014-12-04    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2178-88     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00806988
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MeSH Terms
Descriptor/Qualifier:
Grant Support
ID/Acronym/Agency:
U01 HL088942/HL/NHLBI NIH HHS; U01 HL088942/HL/NHLBI NIH HHS; UM1 HL088955/HL/NHLBI NIH HHS; //Canadian Institutes of Health Research
Investigator
Investigator/Affiliation:
Marissa A Miller / ; Wendy C Taddei-Peters / ; Dennis Buxton / ; Ron Caulder / ; Nancy L Geller / ; David Gordon / ; Neal O Jeffries / ; Albert Lee / ; Claudia S Moy / ; Ilana Kogan Gombos / ; Jennifer Ralph / ; Richard Weisel / ; Timothy J Gardner / ; Patrick T O'Gara / ; Eric A Rose / ; Annetine C Gelijns / ; Michael K Parides / ; Deborah D Ascheim / ; Alan J Moskowitz / ; Ellen Moquete / ; Helena Chang / ; Melissa Chase / ; Yingchun Chen / ; Seth Goldfarb / ; Lopa Gupta / ; Katherine Kirkwood / ; Edlira Kumbarce / ; Ron Levitan / ; Karen O'Sullivan / ; Jessica Overbey / ; Milerva Santos / ; Michael Weglinski / ; Paula Williams / ; Carrie Wood / ; Xia Ye / ; Sten Lyager Nielsen / ; Henrik Wiggers / ; Henning Malgaard / ; Michael Mack / ; Tracine Adame / ; Natalie Settele / ; Jenny Adams / ; William Ryan / ; Robert L Smith / ; Paul Grayburn / ; Frederick Y Chen / ; Anju Nohria / ; Lawrence Cohn / ; Prem Shekar / ; Sary Aranki / ; Gregory Couper / ; Michael Davidson / ; R Morton Bolman / ; Anne Burgess / ; Debra Conboy / ; Nicolas Noiseux / ; Louis-Mathieu Stevens / ; Ignacio Prieto / ; Fadi Basile / ; Joannie Dionne / ; Julie Fecteau / ; Eugene H Blackstone / ; A Marc Gillinov / ; Pamela Lackner / ; Leoma Berroteran / ; Diana Dolney / ; Suzanne Fleming / ; Roberta Palumbo / ; Christine Whitman / ; Kathy Sankovic / ; Denise Kosty Sweeney / ; Gregory Pattakos / ; Pamela A Clarke / ; Michael Argenziano / ; Mathew Williams / ; Lyn Goldsmith / ; Craig R Smith / ; Yoshifumi Naka / ; Allan Stewart / ; Allan Schwartz / ; Daniel Bell / ; Danielle Van Patten / ; Sowmya Sreekanth / ; Peter K Smith / ; John H Alexander / ; Carmelo A Milano / ; Donald D Glower / ; Joseph P Mathew / ; J Kevin Harrison / ; Stacey Welsh / ; Mark F Berry / ; Cyrus J Parsa / ; Betty C Tong / ; Judson B Williams / ; T Bruce Ferguson / ; Alan P Kypson / ; Evelio Rodriguez / ; Malissa Harris / ; Brenda Akers / ; Allison O'Neal / ; John D Puskas / ; Vinod H Thourani / ; Robert Guyton / ; Jefferson Baer / ; Kim Baio / ; Alexis A Neill / ; Pierre Voisine / ; Mario Senechal / ; François Dagenais / ; Kim O'Connor / ; Gladys Dussault / ; Tatiana Ballivian / ; Suzanne Keilani / ; Alan M Speir / ; Patrick Magee / ; Niv Ad / ; Sally Keyte / ; Minh Dang / ; Mark Slaughter / ; Marsha Headlee / ; Heather Moody / ; Naresh Solankhi / ; Emma Birks / ; Mark A Groh / ; Leslie E Shell / ; Stephanie A Shepard / ; Benjamin H Trichon / ; Tracy Nanney / ; Lynne C Hampton / ; Robert E Michler / ; David A D'Alessandro / ; Joseph J DeRose / ; Daniel J Goldstein / ; Ricardo Bello / ; William Jakobleff / ; Mario Garcia / ; Cynthia Taub / ; Daniel Spevak / ; Roger Swayze / ; Louis P Perrault / ; Arsène-Joseph Basmadjian / ; Denis Bouchard / ; Michel Carrier / ; Raymond Cartier / ; Michel Pellerin / ; Jean François Tanguay / ; Ismael El-Hamamsy / ; André Denault / ; Jonathan Lacharité / ; Sophie Robichaud / ; Keith A Horvath / ; Philip C Corcoran / ; Michael P Siegenthaler / ; Mandy Murphy / ; Margaret Iraola / ; Ann Greenberg / ; Chittoor Sai-Sudhakar / ; Ayseha Hasan / ; Asia McDavid / ; Bradley Kinn / ; Pierre Pagé / ; Carole Sirois / ; David Latter / ; Howard Leong-Poi / ; Daniel Bonneau / ; Lee Errett / ; Mark D Peterson / ; Subodh Verma / ; Randi Feder-Elituv / ; Gideon Cohen / ; Campbell Joyner / ; Stephen E Fremes / ; Fuad Moussa / ; George Christakis / ; Reena Karkhanis / ; Terry Yau / ; Michael Farkouh / ; Anna Woo / ; Robert James Cusimano / ; Tirone David / ; Christopher Feindel / ; Lisa Garrard / ; Suzanne Fredericks / ; Amelia Mociornita / ; John C Mullen / ; Jonathan Choy / ; Steven Meyer / ; Emily Kuurstra / ; James S Gammie / ; Cindi A Young / ; Dana Beach / ; Michael A Acker / ; Y Joseph Woo / ; Mary Lou Mayer / ; Michael Bowdish / ; Vaughn A Starnes / ; David Shavalle / ; Ray Matthews / ; Shadi Javadifar / ; Linda Romar / ; Irving L Kron / ; Gorav Ailawadi / ; Karen Johnston / ; John M Dent / ; John Kern / ; Jessica Keim / ; Sandra Burks / ; Kim Gahring / ; David A Bull / ; Patrice Desvigne-Nickens / ; Dennis O Dixon / ; Mark Haigney / ; Richard Holubkov / ; Alice Jacobs / ; Frank Miller / ; John M Murkin / ; John Spertus / ; Andrew S Wechsler / ; Frank Sellke / ; Cheryl L McDonald / ; Robert Byington / ; Neal Dickert / ; Dennis O Dixon / ; John S Ikonomidis / ; David O Williams / ; Clyde W Yancy / ; James C Fang / ; Nadia Giannetti / ; Wayne Richenbacher / ; Vivek Rao / ; Karen L Furie / ; Rachel Miller / ; Sean Pinney / ; William C Roberts / ; Mary N Walsh / ; Stephen J Keteyian / ; Clinton A Brawner / ; Heather Aldred / ; Judy Hung / ; Xin Zeng / ; Joseph P Mathew / ; Jeffrey Browndyke / ; Yanne Toulgoat-Dubois /
Comments/Corrections
Comment In:
N Engl J Med. 2014 Dec 4;371(23):2228-9   [PMID:  25405391 ]

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