This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kang, D.-H. Articles by Lee, J.-W. Search for Related Content PubMed PubMed Citation Articles by Kang, D.-H. Articles by Lee, J.-W. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections CV surgery: coronary artery disease

(Circulation. 2006;114:I-499 – I-503.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mitral Valve Repair Versus Revascularization Alone in the Treatment of Ischemic Mitral Regurgitation

Duk-Hyun Kang, MD, PhD; Mi-Jeong Kim, MD; Soo-Jin Kang, MD; Jong-Min Song, MD, PhD; Hyun Song, MD, PhD; Myeong-Ki Hong, MD, PhD; Kee-Joon Choi, MD, PhD; Jae-Kwan Song, MD, PhD; Jae-Won Lee, MD, PhD

From the Division of Cardiology, Division of Cardiac Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea.

Correspondence to Duk-Hyun Kang, MD, Division of Cardiology, Asan Medical Center, University of Ulsan, Songpa-ku Poongnap-dong 388-1, Seoul 138-736, Korea. E-mail dhkang{at}amc.seoul.kr

Background— For patients with ischemic mitral regurgitation (MR), it is not clear whether adjunctive mitral valve (MV) repair at the time of coronary artery bypass graft surgery (CABG) is beneficial. We sought to test the hypothesis that MV repair with CABG is superior to CABG alone in improving MR without increasing operative or long-term mortality.

Methods and Results— A total of 107 consecutive patients with moderate or severe ischemic MR, as determined by preoperative echocardiography, underwent CABG with concomitant MV repair (repair group, n=50) or CABG only (CABG group, n=57). Degree of MR was graded as none, mild, moderate, or severe by the proximal isovelocity surface area method. The groups were similar with respect to age, gender, baseline New York Heart Association class, ejection fraction, and number of bypass grafts. The repair group had a higher percentage of patients with atrial fibrillation or severe MR than the CABG group. The operative mortality was significantly higher for the repair group (12%) than the CABG group (2%), whereas the 5-year actuarial survival rate of the 2 groups was similar (88%±5% versus 87%±6%). On multivariate logistic regression analysis, older age, higher New York Heart Association class, and atrial fibrillation were independent predictors of operative mortality (P<0.05). Among patients with severe MR, ischemic MR was improved in all patients of the repair group and in 67% of patients in the CABG group (P<0.001), whereas improvement rates in patients with moderate MR were similar in the 2 groups (75% versus 67%, P=NS).

Conclusions— Although MV repair appears to be more effective at reducing ischemic functional MR, CABG alone may be a preferable treatment option for patients with moderate MR and high operative risk factors such as old age or atrial fibrillation.

Key Words: ischemic mitral regurgitation • mitral valve repair • revascularization

This article has been cited by other articles:

				M. Penicka, H. Linkova, O. Lang, R. Fojt, V. Kocka, M. Vanderheyden, and J. Bartunek Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft Surgery Circulation, October 13, 2009; 120(15): 1474 - 1481. [Abstract] [Full Text] [PDF]

				T. Mihaljevic, A. M. Gillinov, and J. F. Sabik III Functional Ischemic Mitral Regurgitation: Myocardial Viability as a Predictor of Postoperative Outcome After Isolated Coronary Artery Bypass Grafting Circulation, October 13, 2009; 120(15): 1459 - 1461. [Full Text] [PDF]