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Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation.
J Thorac Cardiovasc Surg 2014; 147(5):1471-7JT

Abstract

OBJECTIVE

Functional ischemic mitral regurgitation (FIMR) increases mortality independently of the baseline characteristics and ventricular function. The effect of treating FIMR with annuloplasty is unclear when mitral regurgitation is moderate. Myocardial revascularization alone has been shown to improve mitral valve function.

METHODS

We randomized 31 patients with moderate (grade 2-4) FIMR to receive either coronary artery bypass grafting (CABG) alone or CABG plus downsizing mitral ring annuloplasty. The patients were followed up for clinical outcomes and echocardiographic assessment of mitral valve function and left ventricular dimensions at 3 and 12 months. Clinical improvement was assessed using the Minnesota quality-of-life questionnaire, 6-minute walk test, and brain natriuretic peptide levels.

RESULTS

The clinical course was similar in the 2 groups of patients during the study period. FIMR was perfectly corrected intraoperatively in the ring group. Echocardiographic follow-up at 3 months showed no difference in the FIMR grade between the 2 groups (66% less than grade 2 in the CABG alone and 86% in the CABG plus ring group; P = .316). The improvement in the CABG alone group was even more marked at 12 months (85% less than grade 2 in the CABG group and 85% in the CABG plus ring group). The left ventricular ejection fraction was significantly better at 3 months in the CABG alone group, although at 12 months, the left ventricular ejection fraction in the 2 groups had improved similarly.

CONCLUSIONS

Although initially effective at reducing moderate FIMR, the addition of a ring did not change the clinical course after CABG surgery. At 12 months, no echocardiographic difference was found in terms of residual mitral regurgitation, left ventricular dimensions and function, or clinical outcomes.

Authors+Show Affiliations

Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. Electronic address: Denis.Bouchard@icm-mhi.org.Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23856201

Citation

Bouchard, Denis, et al. "Effect of Systematic Downsizing Rigid Ring Annuloplasty in Patients With Moderate Ischemic Mitral Regurgitation." The Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 5, 2014, pp. 1471-7.
Bouchard D, Jensen H, Carrier M, et al. Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2014;147(5):1471-7.
Bouchard, D., Jensen, H., Carrier, M., Demers, P., Pellerin, M., Perrault, L. P., & Lambert, J. (2014). Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery, 147(5), pp. 1471-7. doi:10.1016/j.jtcvs.2013.05.024.
Bouchard D, et al. Effect of Systematic Downsizing Rigid Ring Annuloplasty in Patients With Moderate Ischemic Mitral Regurgitation. J Thorac Cardiovasc Surg. 2014;147(5):1471-7. PubMed PMID: 23856201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation. AU - Bouchard,Denis, AU - Jensen,Henrik, AU - Carrier,Michel, AU - Demers,Philippe, AU - Pellerin,Michel, AU - Perrault,Louis P, AU - Lambert,Jean, Y1 - 2013/07/13/ PY - 2012/12/13/received PY - 2013/01/29/revised PY - 2013/05/23/accepted PY - 2013/7/17/entrez PY - 2013/7/17/pubmed PY - 2014/6/28/medline SP - 1471 EP - 7 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 147 IS - 5 N2 - OBJECTIVE: Functional ischemic mitral regurgitation (FIMR) increases mortality independently of the baseline characteristics and ventricular function. The effect of treating FIMR with annuloplasty is unclear when mitral regurgitation is moderate. Myocardial revascularization alone has been shown to improve mitral valve function. METHODS: We randomized 31 patients with moderate (grade 2-4) FIMR to receive either coronary artery bypass grafting (CABG) alone or CABG plus downsizing mitral ring annuloplasty. The patients were followed up for clinical outcomes and echocardiographic assessment of mitral valve function and left ventricular dimensions at 3 and 12 months. Clinical improvement was assessed using the Minnesota quality-of-life questionnaire, 6-minute walk test, and brain natriuretic peptide levels. RESULTS: The clinical course was similar in the 2 groups of patients during the study period. FIMR was perfectly corrected intraoperatively in the ring group. Echocardiographic follow-up at 3 months showed no difference in the FIMR grade between the 2 groups (66% less than grade 2 in the CABG alone and 86% in the CABG plus ring group; P = .316). The improvement in the CABG alone group was even more marked at 12 months (85% less than grade 2 in the CABG group and 85% in the CABG plus ring group). The left ventricular ejection fraction was significantly better at 3 months in the CABG alone group, although at 12 months, the left ventricular ejection fraction in the 2 groups had improved similarly. CONCLUSIONS: Although initially effective at reducing moderate FIMR, the addition of a ring did not change the clinical course after CABG surgery. At 12 months, no echocardiographic difference was found in terms of residual mitral regurgitation, left ventricular dimensions and function, or clinical outcomes. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/23856201/Effect_of_systematic_downsizing_rigid_ring_annuloplasty_in_patients_with_moderate_ischemic_mitral_regurgitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)00589-8 DB - PRIME DP - Unbound Medicine ER -