Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation

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

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125 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)I499-I503
JournalCirculation
Volume114
Issue numberSUPPL. 1
DOIs
Publication statusPublished - 2006 Jul 1

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Mitral Valve Insufficiency
Mitral Valve
Coronary Artery Bypass
Transplants
Therapeutics
Atrial Fibrillation
Mortality
Echocardiography
Survival Rate
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kang, Duk Hyun ; Kim, Mi Jeong ; Kang, Soo Jin ; Song, Jong Min ; Song, Hyun ; Hong, Myeong Ki ; Choi, Kee Joon ; Song, Jae Kwan ; Lee, Jae Won. / Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. In: Circulation. 2006 ; Vol. 114, No. SUPPL. 1. pp. I499-I503.
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title = "Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation",
abstract = "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.",
author = "Kang, {Duk Hyun} and Kim, {Mi Jeong} and Kang, {Soo Jin} and Song, {Jong Min} and Hyun Song and Hong, {Myeong Ki} and Choi, {Kee Joon} and Song, {Jae Kwan} and Lee, {Jae Won}",
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doi = "10.1161/CIRCULATIONAHA.105.000398",
language = "English",
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Kang, DH, Kim, MJ, Kang, SJ, Song, JM, Song, H, Hong, MK, Choi, KJ, Song, JK & Lee, JW 2006, 'Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation', Circulation, vol. 114, no. SUPPL. 1, pp. I499-I503. https://doi.org/10.1161/CIRCULATIONAHA.105.000398

Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. / Kang, Duk Hyun; Kim, Mi Jeong; Kang, Soo Jin; Song, Jong Min; Song, Hyun; Hong, Myeong Ki; Choi, Kee Joon; Song, Jae Kwan; Lee, Jae Won.

In: Circulation, Vol. 114, No. SUPPL. 1, 01.07.2006, p. I499-I503.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation

AU - Kang, Duk Hyun

AU - Kim, Mi Jeong

AU - Kang, Soo Jin

AU - Song, Jong Min

AU - Song, Hyun

AU - Hong, Myeong Ki

AU - Choi, Kee Joon

AU - Song, Jae Kwan

AU - Lee, Jae Won

PY - 2006/7/1

Y1 - 2006/7/1

N2 - 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.

AB - 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.

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U2 - 10.1161/CIRCULATIONAHA.105.000398

DO - 10.1161/CIRCULATIONAHA.105.000398

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