| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;74:1476-1481
© 2002 The Society of Thoracic Surgeons
a Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
* Address reprint requests to Dr Elefteriades, Section of Cardiothoracic Surgery, Yale University School of Medicine, 121 FMB, 333 Cedar St, New Haven, CT06510, USA.
e-mail: john.elefteriades{at}yale.edu
Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
BACKGROUND: Whether or not to perform adjunctive mitral repair in patients undergoing coronary artery bypass grafting (CABG) for advanced ischemic cardiomyopathy with moderately severe mitral regurgitation (MR) remains controversial.
METHODS: We examine the clinical and echocardiographic outcome after isolated CABG in 49 patients with ischemic cardiomyopathy and 1+ to 3+ MR undergoing surgical revascularization. The patients were identified for analysis of mitral valve-related issues from a larger series of 183 patients with ischemic cardiomyopathy (MUGA ejection fraction 
30%) undergoing CABG by a single surgeon from 1986 to 1996. Patient age was 66.3 years (mean, range 45 to 83 years). There were 5 women (10.2%) and 44 men (89.8%). Mean ejection fraction was 22.4% with a range of 10% to 30%. Thirty-four patients had preoperative congestive heart failure (70%) and 12 (25%) had pulmonary edema. Number of grafts was 2.8 (mean, range 1 to 5). The MR was 1+ in 18 patients (37.5%), 2+ in 26 (52%) and 3+ in 5 patients (10.5%).
RESULTS: Hospital mortality was 2.0% (1 of 49 patients). Ejection fraction improved from 22.0% to 31.5% (p < 0.05) after CABG. Mean degree of MR improved with CABG alone from 1.73 to 0.54 (p < 0.05) as measured at a mean interval of 36.9 months from CABG. New York Heart-Association congestive heart failure class improved from 3.3 to 1.8 (p < 0.05). Long-term survival was 88%, 65%, and 50% at 1, 3, and 5 years postoperatively. No patient required subsequent mitral valve operation or heart transplantation in long-term follow-up.
CONCLUSIONS: We conclude that, in patients with advanced ischemic cardiomyopathy and mild-to-moderate MR, isolated CABG (without mitral valve, repair) suffices, producing dramatic improvement in ejection fraction, in congestive heart failure, and in degree of MR, with excellent (relative) long-term survival. The improvement in MR likely results from improved left ventricular function and size consequent upon revascularization.
This article has been cited by other articles:
|
|
 |
|
  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]
|
|
|
|
 |
|
 K. Fattouch, F. Guccione, R. Sampognaro, G. Panzarella, E. Corrado, E. Navarra, D. Calvaruso, and G. Ruvolo POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J. Thorac. Cardiovasc. Surg., August 1, 2009; 138(2): 278 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]
|
|
|
|
|
|
M. Enriquez-Sarano, D. F. Loulmet, and D. Burkhoff The conundrum of functional mitral regurgitation in chronic heart failure. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 487 - 489. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]
|
|
|
|
 |
|
 A. R. Srivastava, A. Banerjee, S. Jacob, and J. Dunning Should patients undergoing coronary artery bypass grafting with mild to moderate ischaemic mitral regurgitation also undergo mitral valve repair or replacement? Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 538 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Mihaljevic, B.-K. Lam, J. Rajeswaran, M. Takagaki, M. S. Lauer, A. M. Gillinov, E. H. Blackstone, and B. W. Lytle Impact of Mitral Valve Annuloplasty Combined With Revascularization in Patients With Functional Ischemic Mitral Regurgitation J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2191 - 2201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
 |
|
 Y J. Woo, T. J Grand, G. P Liao, and C. M Panlilio Off-pump revascularization for significant left ventricular dysfunction. Asian Cardiovasc Thorac Ann, August 1, 2006; 14(4): 306 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cheng, T. C. Nguyen, M. Malinowski, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Effects of Undersized Mitral Annuloplasty on Regional Transmural Left Ventricular Wall Strains and Wall Thickening Mechanisms Circulation, July 4, 2006; 114(1_suppl): I-600 - I-609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Di Mauro, G. Di Giammarco, G. Vitolla, M. Contini, A. L. Iaco, A. Bivona, L. Weltert, and A. M. Calafiore Impact of No-to-Moderate Mitral Regurgitation on Late Results After Isolated Coronary Artery Bypass Grafting in Patients With Ischemic Cardiomyopathy Ann. Thorac. Surg., June 1, 2006; 81(6): 2128 - 2134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Z. Campwala, R. C. Bansal, N. Wang, A. Razzouk, and R. G. Pai Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 783 - 787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Kohli, H. Wasir, S. Mittal, A. Karlekar, Y. Mehta, and N. Trehan Mitral Valve Repair for Ischemic Mitral Regurgitation in Dilated Cardiomyopathy Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 267 - 270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Levine and E. Schwammenthal Ischemic Mitral Regurgitation on the Threshold of a Solution: From Paradoxes to Unifying Concepts Circulation, August 2, 2005; 112(5): 745 - 758. [Full Text] [PDF]
|
|
|
|
|
|
D. R. Wong, A. K. Agnihotri, J. W. Hung, G. J. Vlahakes, C. W. Akins, A. D. Hilgenberg, J. C. Madsen, T. E. MacGillivray, M. H. Picard, and D. F. Torchiana Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation Ann. Thorac. Surg., August 1, 2005; 80(2): 570 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. J. Woo, T. J. Grand, M. F. Berry, P. Atluri, M. A. Moise, V. M. Hsu, J. Cohen, O. Fisher, J. Burdick, M. Taylor, et al. Stromal cell-derived factor and granulocyte-monocyte colony-stimulating factor form a combined neovasculogenic therapy for ischemic cardiomyopathy J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 321 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Z. Campwala, R. C. Bansal, N. Wang, A. Razzouk, and R. G. Pai Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 104 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Geidel, M. Lass, C. Schneider, G. Groth, S. Boczor, K.-H. Kuck, and J. Ostermeyer Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1011 - 1016. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Braun, J. J. Bax, M. I.M. Versteegh, P. G. Voigt, E. R. Holman, R. J.M. Klautz, E. Boersma, and R. A.E. Dion Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 847 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B-K. Lam, A. M. Gillinov, E. H. Blackstone, J. Rajeswaran, B. Yuh, S. K. Bhudia, P. M. McCarthy, and D. M. Cosgrove Importance of Moderate Ischemic Mitral Regurgitation Ann. Thorac. Surg., February 1, 2005; 79(2): 462 - 470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Diodato, M. R. Moon, M. K. Pasque, H. B. Barner, N. Moazami, J. S. Lawton, M. S. Bailey, T. J. Guthrie, B. F. Meyers, and R. J. Damiano Jr Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: A propensity analysis Ann. Thorac. Surg., September 1, 2004; 78(3): 794 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Calafiore, M. Di Mauro, S. Gallina, G. Di Giammarco, A. L. Iaco, G. Teodori, and I. Tavarozzi Mitral valve surgery for chronic ischemic mitral regurgitation Ann. Thorac. Surg., June 1, 2004; 77(6): 1989 - 1997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. Shah, J. G. Rogers, G. A. Ewald, M. K. Pasque, E. M. Geltman, M. S. Bailey, and N. Moazami Survival of patients removed from the heart transplant waiting list J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1481 - 1485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Grossi When should we attempt to make a silk purse from a sow's ear? J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 618 - 619. [Full Text] [PDF]
|
|
|
|
|
|
H. R. Mallidi, M. P. Pelletier, J. Lamb, N. Desai, J. Sever, G. T. Christakis, G. Cohen, B. S. Goldman, and S. E. Fremes Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 636 - 644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Levine and J. Hung Ischemic mitral regurgitation, the dynamic lesion: clues to the cure J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1929 - 1932. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Dahlberg, T. A. Orszulak, C. J. Mullany, R. C. Daly, M. Enriquez-Sarano, and H. V. Schaff Late outcome of mitral valve surgery for patients with coronary artery disease Ann. Thorac. Surg., November 1, 2003; 76(5): 1539 - 1548. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
