Title of article :
Importance of Moderate Ischemic Mitral Regurgitation
Author/Authors :
Buu-Khanh Lam، نويسنده , , A. Marc Gillinov، نويسنده , , Eugene H. Blackstone، نويسنده , , Jeevanantham Rajeswaran، نويسنده , , Bertram Yuh، نويسنده , , Sunil K. Bhudia، نويسنده , , Patrick M. McCarthy، نويسنده , , Delos M. Cosgrove III، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2005
Abstract :
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.
Journal title :
The Annals of Thoracic Surgery
Journal title :
The Annals of Thoracic Surgery