| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2005;79:462-470
© 2005 The Society of Thoracic Surgeons
a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio
Accepted for publication July 14, 2004.
* Address reprint requests to Dr Gillinov, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: gillinom{at}ccf.org).
Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
BACKGROUND: The importance of moderate ischemic mitral regurgitation in patients presenting for coronary artery bypass grafting (CABG) is controversial. Therefore, we tracked the course of unrepaired moderate ischemic mitral regurgitation after CABG surgery alone, identified factors associated with worsening postoperative ischemic mitral regurgitation, and assessed the impact of unrepaired moderate ischemic mitral regurgitation on survival.
METHODS: From 1980 to 2000, 467 patients with moderate ischemic mitral regurgitation underwent CABG alone. The course of unrepaired mitral regurgitation was estimated by a longitudinal analysis of 267 follow-up echocardiograms from 156 patients. The survival impact of moderate ischemic mitral regurgitation was determined among propensity-matched patients with and without ischemic mitral regurgitation.
RESULTS: Mitral regurgitation was dynamic early postoperatively. Immediately postoperatively, it was absent or mild in 73% and severe in 6%; by 6 weeks, these figures were 40% and 22%, respectively. The course of postoperative mitral regurgitation was not associated with the preoperative extent of coronary artery disease or left ventricular dysfunction. Five-year survival of matched bypass patients without ischemic mitral regurgitation was 85% compared with 73% for patients with moderate ischemic mitral regurgitation (p = 0.003).
CONCLUSIONS: Moderate ischemic mitral regurgitation does not reliably resolve with CABG surgery alone and is associated with reduced survival. Therefore, a mitral valve procedure may be warranted for such patients presenting for CABG. A randomized trial comparing strategies of revascularization with mitral valve repair and revascularization alone is required to determine optimal treatment.
This article has been cited by other articles:
|
|
 |
|
  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]
|
|
|
|
|
|
J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]
|
|
|
|
|
|
M. LeBoutillier III and V. J. DiSesa Valvular and Ischemic Heart Disease Card. Surg. Adult, January 1, 2008; 3(2008): 1175 - 1192. [Full Text]
|
|
|
|
 |
|
 P. C. Austin Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1128 - 1135. [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]
|
|
|
|
|
|
M. Fukuoka, M. Nonaka, S. Masuyama, T. Shimamoto, K. Tambara, H. Yoshida, T. Ikeda, and M. Komeda Chordal "translocation" for functional mitral regurgitation with severe valve tenting: An effort to preserve left ventricular structure and function J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1004 - 1011. [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]
|
|
|
|
 |
|
 E. A. Grossi, G. A. Crooke, P. L. DiGiorgi, C. F. Schwartz, U. Jorde, R. M. Applebaum, G. H. Ribakove, A. C. Galloway, J. B. Grau, and S. B. Colvin Impact of Moderate Functional Mitral Insufficiency in Patients Undergoing Surgical Revascularization Circulation, July 4, 2006; 114(1_suppl): I-573 - I-576. [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]
|
|
|
|
|
|
M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink? Ann. Thorac. Surg., March 1, 2006; 81(3): 1153 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Cohn Percutaneous Mitral Valve Repair With the Edge-to-Edge Technique: A Surgeon's Perspective J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2141 - 2142. [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]
|
|
|
|
|
|
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]
|
|
| 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 |
