Surgical Management of Ischemic Mitral Regurgitation

Badiwala, Mitesh; Verma, Subodh; Rao, Vivek

doi:10.1161/circulationaha.108.836627

Cited by 31 publications

(18 citation statements)

References 56 publications

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“…16 Alternatively, MV repair may primarily affect other important end points, such as heart failure and adverse remodeling of the LV. 8,17 Our findings agree with the results of previous studies showing that percutaneous and surgical revascularization had comparable long-term survival 4,10 and that MV repair was insufficient to improve long-term survival. 6,7,18 However, to our knowledge, the present study is the first prospective study to demonstrate that compared with revascularization alone, additional mitral annuloplasty significantly improved functional status and long-term event-free survival by decreasing the incidence of persistent and recurrent IMR to 6%.…”

Section: Discussionsupporting

confidence: 91%

“…Restrictive mitral annuloplasty currently is considered the standard surgical therapy for IMR, 8 but long-term failures of mitral annuloplasty are increasingly recognized. 22,23 Progressive ventricular remodeling in ischemic heart disease can increase tethering and render initial successful repair ineffective.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 To date, no prospective trial has addressed the impact of therapies intended to reduce MR on symptoms, LV function, and clinical end points. 5,8 Using our prospectively collected registry data on patients with IMR, we sought to compare the long-term outcomes of percutaneous versus surgical revascularization and to evaluate the impact of additional mitral annuloplasty on clinical and echocardiographic outcomes.…”

mentioning

confidence: 99%

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Percutaneous Versus Surgical Revascularization in Patients With Ischemic Mitral Regurgitation

et al. 2011

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Background-The proper way of revascularization remains controversial in patients with ischemic mitral regurgitation (IMR). We sought to compare the long-term results of percutaneous coronary intervention (PCI) and surgical revascularization in IMR. Methods and Results-From 1996 to 2008, 185 consecutive patients (132 men; age, 63Ϯ9 years) with significant IMR underwent PCI (PCI group) (nϭ66) or coronary artery bypass graft surgery (OP group) (nϭ119). In the OP group, 68 (57%) patients also underwent concomitant mitral annuloplasty. Significant IMR was defined as functional MR occurring Ͼ1 week after myocardial infarction with an effective regurgitant orifice area Ն0.2 cm 2 . During a median follow-up of 54 months, there were 2 operative mortalities, 26 cardiac deaths, and 11 heart failure hospitalizations in the OP group and 22 cardiac deaths and 10 heart failure hospitalizations in the PCI group. The survival and cardiac mortality rates were not significantly different between the 2 groups, but event-free survival rates were significantly higher in the OP group. For the 45 propensity score-matched pairs, the risk of cardiac events was significantly lower in the OP group than in the PCI group (hazard ratio, 0.499; 95% CI, 0.251 to 0.990; Pϭ0.043). Compared with patients who underwent coronary artery bypass graft surgery alone, event-free survival rates were significantly higher in those who underwent additional mitral annuloplasty. Conclusions-Compared with PCI, surgical revascularization is associated with an improved long-term event-free survival, and concomitant mitral annuloplasty should be considered in patients with significant IMR. (Circulation. 2011;124[suppl 1]:S156 -S162.)

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Percutaneous Versus Surgical Revascularization in Patients With Ischemic Mitral Regurgitation

et al. 2011

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“…9 Moreover, postoperative improvement of LV dysfunction by CABG alone cannot be predicted reliably, 23 and some have advocated that correction of MR may allow for significant reverse LV remodeling after surgery. 32, 49, 50 The Randomized Ischemic Mitral Evaluation (RIME) Trial (ClinicalTrials.gov NCT00413998) has provided additional support for potential benefits of MV repair in addition to CABG by demonstrating greater improvement in functional capacity as measured by peak oxygen consumption, and greater left ventricular reverse remodeling as measured by the left ventricular end-systolic volume index, reduction in mitral regurgitation severity, and B-type natriuretic peptide levels, compared with the CABG alone.…”

Section: Discussionmentioning

confidence: 99%

“…1, 2 Ischemic mitral regurgitation (IMR) has been reported to occur in more than 50% of patients after an acute MI, representing a distinct clinical entity from degenerative structural causes of mitral valve (MV) insufficiency. 3–8 The presence of IMR is associated with poor outcomes, 9 and while outcomes are worse with increasing IMR severity, even mild IMR portends a significantly increased risk of heart failure and death. 10–16 …”

Section: Introductionmentioning

confidence: 99%

Surgical Revascularization Is Associated With Maximal Survival in Patients With Ischemic Mitral Regurgitation

et al. 2014

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Background The optimal treatment for ischemic mitral regurgitation (IMR) remains actively debated. Our objective was to evaluate the relationship between IMR treatment strategy and survival. Methods and Results We retrospectively reviewed patients at our institution diagnosed with significant coronary artery disease and moderate or severe IMR from 1990–2009, categorized by medical treatment alone (MED), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or CABG + mitral valve repair or replacement (MVRR). Kaplan-Meier methods and multivariable Cox proportional hazard analyses were performed to assess the relationship between treatment strategy and survival, using propensity scores to account for nonrandom treatment assignment. A total of 4,989 patients were included: MED = 36%, PCI = 26%, CABG = 33%, and CABG+MVRR = 5%. Median follow-up was 5.37 years. Compared to MED, significantly lower mortality was observed in patients treated with PCI [adjusted hazard ratio (AHR): 0.83, 95% confidence interval (CI): 0.76 – 0.92, p=0.0002], CABG (AHR: 0.56, CI: 0.51 – 0.62, p<0.0001), and CABG+MVRR (AHR: 0.69, CI: 0.57 – 0.82, p<0.0001). There was no significant difference in these results based on MR severity. Conclusions Patients with significant coronary artery disease and moderate or severe IMR undergoing CABG alone demonstrated the lowest risk of death. CABG with or without mitral valve surgery was associated with lower mortality than either PCI or MED.

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Surgical Intervention on the Mitral and Tricuspid Valves in Patients with Left Ventricular Dysfunction and Heart Failure

Rao

2019

Heart Failure

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Surgical Management of Ischemic Mitral Regurgitation

Cited by 31 publications

References 56 publications

Percutaneous Versus Surgical Revascularization in Patients With Ischemic Mitral Regurgitation

Percutaneous Versus Surgical Revascularization in Patients With Ischemic Mitral Regurgitation

Surgical Revascularization Is Associated With Maximal Survival in Patients With Ischemic Mitral Regurgitation

Surgical Intervention on the Mitral and Tricuspid Valves in Patients with Left Ventricular Dysfunction and Heart Failure

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