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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2018 Mar 12

DOI: 10.23736/S0021-9509.18.10413-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Moderate ischemic mitral regurgitation. Coronary artery bypass grafting with versus without simultaneous treatment of the mitral valve is associated with comparable long-term survival

Jonathan RILINGER 1 , Claudia HEILMANN 2, Ulrich BEITINGER 2, Christoph B. OLIVIER 1, Philipp DIEHL 1, Friedhelm BEYERSDORF 2, Matthias SIEPE 2

1 Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany; 2 Department of Cardiovascular Surgery, Freiburg University Heart Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany


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BACKGROUND: Ischemic mitral regurgitation (IMR) is a frequent complication of coronary artery heart disease and is associated with increased mortality. Controversies exists whether patients with moderate IMR may benefit from a combined procedure with coronary artery bypass grafting (CABG) and treatment of mitral regurgitation.
METHODS: 451 patients with moderate IMR (grade 2) receiving either CABG alone (CABG only) or additional mitral valve repair or replacement (CABG+MV) were included in this observational single-centre study. Patients were matched according to the number of bypass grafts, preoperative NYHA functional class and age. In total, 42 patients (21 CABG only, 21 CABG+MV) were analysed.
RESULTS: The mean follow-up was 4.3 ± 1.9 years. CABG alone reduced the IMR grade to 1.2 ± 0.5, whereas the combined procedure resulted in a decrease to 0.6 ± 0.7 (p=0.039). NYHA functional class was reduced from grade 2.8 ± 0.6 to 1.6 ± 0.5 (CABG only) and 2.0 ± 1.1 (CABG+MV, p=0.55). 3- and 5-year survival rates were 71% and 53% in the CABG only group compared to 60% both after 3 and 5 years in the CABG+MV group (p=0.89).
CONCLUSIONS: In this observational study, combined CABG and surgical treatment of moderate IMR was associated with a more effective reduction of IMR than CABG alone. Nevertheless, no differences in survival or NYHA functional class were observed. Further studies will need to investigate the value of additional mitral valve surgery in moderate IMR.


KEY WORDS: Ischemic mitral regurgitation - Moderate - Mitral valve repair - Mitral valve replacement - Coronary artery bypass graft

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Publication History

Article first published online: March 12, 2018
Manuscript accepted: March 12, 2018
Manuscript received: January 14, 2018

Cite this article as

Rilinger J, Heilmann C, Beitinger U, Olivier CB, Diehl P, Beyersdorf F, et al. Moderate ischemic mitral regurgitation. Coronary artery bypass grafting with versus without simultaneous treatment of the mitral valve is associated with comparable long-term survival. J Cardiovasc Surg 2018 Mar 12. DOI: 10.23736/S0021-9509.18.10413-7

Corresponding author e-mail

jonathan.rilinger@universitaets-herzzentrum.de