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Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial
Marek A Deja1, Paul A Grayburn, Benjamin Sun
1Medical University of Silesia, Katowice, Poland. mdeja@sum.edu.pl
Circulation
|May 4, 2012
Summary
Adding mitral valve repair to coronary artery bypass grafting (CABG) may improve survival for patients with ischemic mitral regurgitation (MR). Further randomized trials are needed to confirm these findings for ischemic heart disease patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Heart Valve Disease
Background:
- Ischemic mitral regurgitation (MR) is a common complication in patients with coronary artery disease and left ventricular dysfunction.
- The optimal management strategy for moderate to severe ischemic MR during coronary artery bypass grafting (CABG) remains uncertain.
- This study investigates the impact of mitral valve repair on survival in this patient population.
Purpose of the Study:
- To evaluate whether mitral valve repair during CABG improves survival in patients with ischemic MR.
- To compare outcomes of medical therapy alone, CABG alone, and CABG with mitral valve repair.
Main Methods:
- A randomized trial involving 1212 patients with ejection fraction ≤35% and coronary artery disease amenable to CABG.
- Patients were randomized to medical therapy with or without CABG; mitral valve treatment was at the surgeon's discretion.
- The primary endpoint was mortality.
Main Results:
- Among patients with moderate to severe MR, those who underwent CABG with mitral surgery had a lower mortality rate (43%) compared to those receiving medical therapy alone (50%).
- Compared to CABG alone, CABG with mitral surgery showed a significantly reduced hazard ratio for mortality (0.41; P=0.006).
- Observational data suggested improved survival with mitral valve repair added to CABG for moderate to severe MR.
Conclusions:
- Adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe ischemic MR may improve survival.
- These findings are based on observational data and require confirmation.
- A prospective randomized trial is necessary to definitively establish the benefits of combined surgical approach.
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