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Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve).
J Thorac Cardiovasc Surg 2011; 141(1):91-7JT

Abstract

OBJECTIVE

Functional ischemic mitral regurgitation is a complication of ventricular remodeling; standard therapy is reduction annuloplasty and coronary artery bypass grafting. Unfortunately, outcomes are retrospective and contradictory. We report a multicenter study that documents the outcomes of reduction annuloplasty for functional ischemic mitral regurgitation.

METHODS

Twenty-one centers randomized 75 patients to the coronary artery bypass grafting + reduction annuloplasty subgroup that was the control arm of the Randomized Evaluation of a Surgical Treatment for Off-pump Repair of the Mitral Valve trial. Entry criteria included patients requiring revascularization, patients with severe or symptomatic moderate functional ischemic mitral regurgitation, an ejection fraction 25% or greater, a left ventricular end-diastolic dimension 7.0 cm or less, and more than 30 days since acute myocardial infarction. All echocardiograms were independently scored by a core laboratory. Reduction annuloplasty was achieved by device annuloplasty. Two patients underwent immediate intraoperative conversion to a valve replacement because reduction annuloplasty was unable to correct mitral regurgitation; as-treated results are presented.

RESULTS

Thirty-day mortality was 4.1% (3/73). Patients received an average of 2.8 bypass grafts. Mean follow-up was 24.6 months. Mitral regurgitation was reduced from 2.6 ± 0.8 preoperatively to 0.3 ± 0.6 at 2 years. Freedom from death or valve reoperation was 78% ± 5% at 2 years. There was significant improvement in ejection fraction and New York Heart Association class with reduction of left ventricular end-diastolic dimension. Cox regression analyses suggested that increasing age (P = .001; hazard ratio, 1.16 per year; 95% confidence interval, 1.06-1.26) and renal disease (P = .018; hazard ratio, 3.48; 95% confidence interval, 1.25-9.72) were associated with decreased survival.

CONCLUSIONS

Coronary artery bypass grafting + reduction annuloplasty for functional ischemic mitral regurgitation predictably reduces mitral regurgitation and relieves symptoms. This treatment of moderate to severe mitral regurgitation is associated with improved indices of ventricular function, improved New York Heart Association class, and excellent freedom from recurrent mitral insufficiency. Although long-term prognosis remains guarded, this multicenter study delineates the intermediate-term benefits of such an approach.

Authors+Show Affiliations

New York University School of Medicine, New York, NY 10016, USA. Eugene.grossi@nyumc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

21168015

Citation

Grossi, Eugene A., et al. "Outcomes of Coronary Artery Bypass Grafting and Reduction Annuloplasty for Functional Ischemic Mitral Regurgitation: a Prospective Multicenter Study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve)." The Journal of Thoracic and Cardiovascular Surgery, vol. 141, no. 1, 2011, pp. 91-7.
Grossi EA, Woo YJ, Patel N, et al. Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). J Thorac Cardiovasc Surg. 2011;141(1):91-7.
Grossi, E. A., Woo, Y. J., Patel, N., Goldberg, J. D., Schwartz, C. F., Subramanian, V. A., ... Trehan, N. (2011). Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). The Journal of Thoracic and Cardiovascular Surgery, 141(1), pp. 91-7. doi:10.1016/j.jtcvs.2010.08.057.
Grossi EA, et al. Outcomes of Coronary Artery Bypass Grafting and Reduction Annuloplasty for Functional Ischemic Mitral Regurgitation: a Prospective Multicenter Study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). J Thorac Cardiovasc Surg. 2011;141(1):91-7. PubMed PMID: 21168015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). AU - Grossi,Eugene A, AU - Woo,Y Joseph, AU - Patel,Nirav, AU - Goldberg,Judith D, AU - Schwartz,Charles F, AU - Subramanian,Valavanur A, AU - Genco,Christopher, AU - Goldman,Scott M, AU - Zenati,Marco A, AU - Wolfe,J Alan, AU - Mishra,Yugal K, AU - Trehan,Naresh, PY - 2010/06/18/received PY - 2010/08/05/revised PY - 2010/08/24/accepted PY - 2010/12/21/entrez PY - 2010/12/21/pubmed PY - 2011/1/14/medline SP - 91 EP - 7 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 141 IS - 1 N2 - OBJECTIVE: Functional ischemic mitral regurgitation is a complication of ventricular remodeling; standard therapy is reduction annuloplasty and coronary artery bypass grafting. Unfortunately, outcomes are retrospective and contradictory. We report a multicenter study that documents the outcomes of reduction annuloplasty for functional ischemic mitral regurgitation. METHODS: Twenty-one centers randomized 75 patients to the coronary artery bypass grafting + reduction annuloplasty subgroup that was the control arm of the Randomized Evaluation of a Surgical Treatment for Off-pump Repair of the Mitral Valve trial. Entry criteria included patients requiring revascularization, patients with severe or symptomatic moderate functional ischemic mitral regurgitation, an ejection fraction 25% or greater, a left ventricular end-diastolic dimension 7.0 cm or less, and more than 30 days since acute myocardial infarction. All echocardiograms were independently scored by a core laboratory. Reduction annuloplasty was achieved by device annuloplasty. Two patients underwent immediate intraoperative conversion to a valve replacement because reduction annuloplasty was unable to correct mitral regurgitation; as-treated results are presented. RESULTS: Thirty-day mortality was 4.1% (3/73). Patients received an average of 2.8 bypass grafts. Mean follow-up was 24.6 months. Mitral regurgitation was reduced from 2.6 ± 0.8 preoperatively to 0.3 ± 0.6 at 2 years. Freedom from death or valve reoperation was 78% ± 5% at 2 years. There was significant improvement in ejection fraction and New York Heart Association class with reduction of left ventricular end-diastolic dimension. Cox regression analyses suggested that increasing age (P = .001; hazard ratio, 1.16 per year; 95% confidence interval, 1.06-1.26) and renal disease (P = .018; hazard ratio, 3.48; 95% confidence interval, 1.25-9.72) were associated with decreased survival. CONCLUSIONS: Coronary artery bypass grafting + reduction annuloplasty for functional ischemic mitral regurgitation predictably reduces mitral regurgitation and relieves symptoms. This treatment of moderate to severe mitral regurgitation is associated with improved indices of ventricular function, improved New York Heart Association class, and excellent freedom from recurrent mitral insufficiency. Although long-term prognosis remains guarded, this multicenter study delineates the intermediate-term benefits of such an approach. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/21168015/Outcomes_of_coronary_artery_bypass_grafting_and_reduction_annuloplasty_for_functional_ischemic_mitral_regurgitation:_a_prospective_multicenter_study__Randomized_Evaluation_of_a_Surgical_Treatment_for_Off_Pump_Repair_of_the_Mitral_Valve__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(10)01059-7 DB - PRIME DP - Unbound Medicine ER -