PMID- 17543639
OWN - NLM
STAT- MEDLINE
DCOM- 20070705
LR  - 20220408
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 49
IP  - 22
DP  - 2007 Jun 5
TI  - Impact of mitral valve annuloplasty combined with revascularization in patients 
      with functional ischemic mitral regurgitation.
PG  - 2191-201
AB  - OBJECTIVES: The aim of this work was to determine whether mitral valve (MV) 
      annuloplasty benefits patients with moderate/severe (3+/4+) functional ischemic 
      mitral regurgitation (MR) who undergo coronary artery bypass grafting (CABG). 
      BACKGROUND: Mitral regurgitation is a strong predictor of poor outcomes in 
      patients with ischemic cardiomyopathy; whether correcting it at the time of CABG 
      improves outcomes is less certain. METHODS: From 1991 to 2003, 390 patients with 
      3+/4+ ischemic MR had CABG with (n = 290) or without (n = 100) MV annuloplasty. 
      Groups were propensity-matched using demographics, extent of coronary disease, 
      regional wall motion, and quantitative electrocardiography. Survival, 
      echocardiographic severity of MR, and New York Heart Association (NYHA) 
      functional class were compared. RESULTS: One-, 5-, and 10-year survival was 88%, 
      75%, and 47% after CABG alone and 92%, 74%, and 39% after CABG + MV annuloplasty 
      (p = 0.6). Mortality was increased in patients with severe lateral wall motion 
      abnormalities (p = 0.05), ST-segment elevation in lateral leads (p < 0.004), and 
      higher QRS voltage sum (p < 0.0001). Patients undergoing CABG alone were more 
      likely to have 3+/4+ postoperative MR than those undergoing CABG + MV 
      annuloplasty (48% vs. 12% at 1 year, p < 0.0001). The NYHA functional class 
      substantially improved in both groups (p < 0.001) and remained improved; at 5 
      years, 23% of patients having CABG + mitral annuloplasty and 25% having CABG 
      alone were in NYHA functional class III/IV. CONCLUSIONS: Although CABG + MV 
      annuloplasty reduces postoperative MR and improves early symptoms compared with 
      CABG alone, it does not improve long-term functional status or survival in 
      patients with severe functional ischemic MR. The MV annuloplasty in this setting, 
      without addressing fundamental ventricular pathology, is insufficient to improve 
      long-term clinical outcomes.
FAU - Mihaljevic, Tomislav
AU  - Mihaljevic T
AD  - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, 
      Ohio 44195, USA. mihaljt@ccf.org
FAU - Lam, Buu-Khanh
AU  - Lam BK
FAU - Rajeswaran, Jeevanantham
AU  - Rajeswaran J
FAU - Takagaki, Masami
AU  - Takagaki M
FAU - Lauer, Michael S
AU  - Lauer MS
FAU - Gillinov, A Marc
AU  - Gillinov AM
FAU - Blackstone, Eugene H
AU  - Blackstone EH
FAU - Lytle, Bruce W
AU  - Lytle BW
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
DEP - 20070518
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2007 Jun 5;49(22):2202-3. PMID: 17543640
MH  - Aged
MH  - Cardiac Surgical Procedures/methods
MH  - Coronary Artery Bypass/methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/physiopathology/surgery
MH  - Mitral Valve Insufficiency/mortality/physiopathology/*surgery
MH  - *Myocardial Revascularization/methods
MH  - Survival Rate
EDAT- 2007/06/05 09:00
MHDA- 2007/07/06 09:00
CRDT- 2007/06/05 09:00
PHST- 2006/09/08 00:00 [received]
PHST- 2007/02/05 00:00 [revised]
PHST- 2007/02/05 00:00 [accepted]
PHST- 2007/06/05 09:00 [pubmed]
PHST- 2007/07/06 09:00 [medline]
PHST- 2007/06/05 09:00 [entrez]
AID - S0735-1097(07)00979-5 [pii]
AID - 10.1016/j.jacc.2007.02.043 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Jun 5;49(22):2191-201. doi: 10.1016/j.jacc.2007.02.043. 
      Epub 2007 May 18.