Coronary Artery Bypass Surgery With or Without Mitral Valve Annuloplasty in Moderate Functional Ischemic Mitral Regurgitation

Abstract

for the RIME Investigators Background-The role of mitral valve repair (MVR) during coronary artery bypass grafting (CABG) in patients with moderate ischemic mitral regurgitation (MR) is uncertain. We conducted a randomized, controlled trial to determine whether repairing the mitral valve during CABG may improve functional capacity and left ventricular reverse remodeling compared with CABG alone. Methods and Results-Seventy-three patients referred for CABG with moderate ischemic MR and an ejection fraction Ͼ30%were randomized to receive CABG plus MVR (34 patients) or CABG only (39 patients). The study was stopped early after review of interim data. At 1 year, there was a greater improvement in the primary end point of peak oxygen consumption in the CABG plus MVR group compared with the CABG group (3.3 mL/kg/min versus 0.8 mL/kg/min; PϽ0.001). There was also a greater improvement in the secondary end points in the CABG plus MVR group compared with the CABG group: left ventricular end-systolic volume index, MR volume, and plasma B-type natriuretic peptide reduction of 22.2 mL/m

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

“…12) Mitral valve surgery decreased the serum BNP levels of MR patients. [13][14][15] However, little is known about the response of NT-pro BNP levels after MC implantation; therefore, the determinants of the NT-pro BNP response after this procedure still remain unknown. In this study, we aimed to clarify the response of NTpro BNP after MC and to identify the determinants of nonresponse among patients with severe MR and HF undergoing MC.…”

Predictors and Clinical Impact of Functional Mitral Stenosis Induced by Restrictive Annuloplasty for Ischemic and Functional Mitral Regurgitation

“…The purpose of the present study was to elucidate the preoperative risk factors and hemodynamic determinants of an increase in the postoperative MV pressure gradient created by RMA, as well F unctional mitral regurgitation (MR) is a common complication of both ischemic and non-ischemic advanced cardiomyopathy, and its presence in the setting of severe systolic left ventricular (LV) dysfunction is strongly associated with poor outcome. 1,2 Currently, a restrictive mitral annuloplasty (RMA) technique utilizing an undersized prosthetic ring is the preferred surgical option to treat moderate to severe functional MR. [3][4][5][6][7][8] Recently, there has been increasing interest in iatrogenic "functional" mitral stenosis by implantation of an undersized annuloplasty ring, which leads to an increased gradient across the mitral valve (MV) after valvular repair. 9- 14 Magne et al noted a high incidence of functional MV ste-Determinants of Mitral Gradient Following RMA calculated from continuous-wave Doppler echocardiography findings using the Bernoulli equation.…”

Managing Heart Failure Patients with Multivessel Disease — Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention

“…36 Data from the (Randomised Ischemic Mitral Regurgitation (RIME) trial, a prospective randomised comparison of coronary bypass surgery alone versus surgery combined with mitral annuloplasty for moderate ischaemic mitral regurgitation, showed a significant improvement in the primary outcome, myocardial oxygenation consumption at 1 year (22 % increase from baseline for coronary bypass gratfing plus mitral annuloplasty versus 5 % for coronary bypass gratfing alone; P<0.001). 37 There was also greater symptomatic improvement and significant reverse remodelling.…”