Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation

By R. Michler, Peter K. Smith, M. Parides, G. Ailawadi, V. Thourani, A. Moskowitz, M. Acker, J. Hung, Helena L. Chang, L. Perrault and 22 more. New England Journal of Medicine, 2016

666 citations recorded by the source corpus.

BACKGROUND In a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus mitral-valve repair in patients with moderate ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation, but patients had more adverse events. We now report 2-year outcomes. METHODS We randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. RESULTS At 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-procedure group (hazard ratio in the combined-procedure group, 0.90; 95% confidence interval, 0.45 to 1.83; P=0.78). There was no significant between-group difference in the rank-based assessment of the LVESVI (including death) at 2 years (z score, 0.38; P = 0.71). The 2-year rate of moderate or severe residual mitral regurgitation was higher in the CABG-alone group than in the combined-procedure group (32.3% vs. 11.2%, P<0.001). Overall rates of hospital readmission and serious adverse events were similar in the two groups, but neurologic events and supraventricular arrhythmias remained more frequent in the combined-procedure group. CONCLUSIONS In patients with moderate ischemic mitral regurgitation undergoing CABG, the addition of mitral-valve repair did not lead to significant differences in left ventricular reverse remodeling at 2 years. Mitral-valve repair provided a more durable correction of mitral regurgitation but did not significantly improve survival or reduce overall adverse events or readmissions and was associated with an early hazard of increased neurologic and supraventricular arrhythmias.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Surgery

View Paper: https://www.semanticscholar.org/paper/c82c568427756d5bcc84848164fdb4bae3572d79

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Citations in the corpus

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “001), even though LV reverse remodeling was similar in both groups (71).”
2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “001), even though LV reverse remodeling was similar in both groups (71).”
2018 ESC/EACTS Guidelines on myocardial revascularization. (2019, critical): “The CTSN trial showed that addition of surgical mitral valve repair to CABG made no significant difference to survival, overall reduction of adverse events, or LV reverse remodelling at 2 years.(308,309) Increased length of intensive care and hospital stay and perioperative morbidity, including neur”
Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. (2017, background): “39 cm(2)) did not improve outcome and was associated with an increased hazard of neurologic events and supraventricular arrhythmias.(169) Finally, in patients with severe MR treated with the MitraClip, reduction of MR severity was associated with favorable LV and LA remodeling and improved functiona”
[2017 ESC/EACTS Guidelines for the management of valvular heart disease]. (2017, background): “A recent randomized controlled trial could not show a benefit of concomitant valve surgery.(141) Surgery is more likely to be considered if myocardial viability is present and if comorbidity is low.”