Abstract 12057: Mitral Valve Annuloplasty in Addition to Coronary Artery Bypass Grafting in Moderate Functional Ischemic Mitral Regurgitation Reverses Left Ventricular Remodelling and Restores Left Ventricular Geometry: Preliminary Results of the Randomised Ischemic Mitral Evaluation Trial
BACKGROUND: The optimal treatment of moderate functional ischemic mitral regurgitation (FIMR) is uncertain. There is controversy over whether the addition of mitral valve annuloplasty (MVA) to coronary artery bypass grafting (CABG) improves outcome.
HYPOTHESIS: MVA in addition to CABG reverses left ventricular (LV)remodelling and restores LV geometry.
METHODS: 38 patients with moderate FIMR were randomised to either CABG alone or CABG plus MVA as part of the Randomised Ischemic Mitral Evaluation (RIME) Trial. Echocardiography, cardiovascular magnetic resonance and plasma BNP levels were measured at baseline and one year.
RESULTS: At one year following surgery, CABG alone did not result in any significant change in mitral regurgitation severity (regurgitant volume decrease 14.5%, p=0.27), LV volumes (LVESVI decrease 10.2%, p=0.16) or LV geometry (LV sphericity increase 1.7%, p=0.38). In contrast, addition of MVA to CABG significantly reduced mitral regurgitation severity (regurgitant volume decrease 69.2%, p=0.005), reduced LV volumes (LVESVI decrease 24.4%, p=0.05), and restored LV geometry to a more elliptical and less spherical shape (LV sphericity decrease 17.9%, p=0.01). MVA also reduced mitral annular size (septolateral diameter decrease 16.7%, p=0.002), and reduced leaflet motion (maximal leaflet separation decrease 34.8%, p=0.0008). Plasma BNP levels were significantly elevated at baseline in both groups (CABG: 267.4 ± 120.8 pmol/l, MVA+CABG: 235.8 ± 117.2 pmol/l) and was reduced in both groups at one year (CABG: 49.8 ± 27.9 pmol/l, p=0.02; MVA+CABG: 56.6 ± 26.1 pmol/l, p=0.03).
CONCLUSION: Compared to CABG only, the addition of MVA in moderate FIMR significantly reduces mitral regurgitation severity, reverses LV remodelling, and restores LV geometry. Mitral leaflet motion is significantly reduced after MVA. BNP levels were reduced by similar amounts after both CABG alone and MVA plus CABG but remained significantly elevated.
- © 2011 by American Heart Association, Inc.