HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hari R. Mallidi Marc P. Pelletier Nimesh Desai George T. Christakis Gideon Cohen Bernard S. Goldman Stephen E. Fremes Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mallidi, H. R. Articles by Fremes, S. E. Search for Related Content PubMed PubMed Citation Articles by Mallidi, H. R. Articles by Fremes, S. E. Related Collections Related Article

J Thorac Cardiovasc Surg 2004;127:636-644
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting

^a Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication May 2, 2003; revisions received August 25, 2003; revisions received September 15, 2003; accepted for publication September 17, 2003.

^* Address for reprints: Marc P. Pelletier, MD, Assistant Professor of Surgery, Staff Cardiovascular Surgeon, Department of Surgery, Division of Cardiovascular Surgery, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario , M4N 3M5 Canada.
marc.pelletier{at}sw.ca

OBJECTIVES: Patients undergoing coronary artery bypass grafting often have untreated mild to moderate mitral regurgitation. The long-term outcome of these patients follows an uncertain course. The purpose of this study was to examine the late outcomes in patients with mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.

METHODS: One hundred sixty-three patients with mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting were identified from the prospectively collected cardiovascular database at Sunnybrook and Women's College Health Sciences Centre. These patients were matched 1:2 with patients who had isolated coronary artery bypass grafting without mitral regurgitation according to gender, age, left ventricular ejection fraction, New York Heart Association functional class, vascular disease, diabetes, extent of coronary disease, and year of surgery. There was 99% complete follow-up. Actuarial survival and event-free (death, myocardial infarction, stroke, cardiac hospitalization, and cardiac reintervention) survivals were compared by log-rank methods. Cox regression was used to assess the effects of the presence of mitral regurgitation on late survival and event-free survival. Preliminary postoperative follow-up echocardiography was available for 49 of the 163 patients with mitral regurgitation.

RESULTS: There were 489 patients in the matched-cohort study, 163 with mitral regurgitation and 326 without. The average length of follow-up was 3.37 ± 2.04 years. There was no difference in actuarial survival at 6 postoperative years (mitral regurgitation 81.0% vs no mitral regurgitation 84.7%, P = .9185). Event-free survival at 6 years was worse in the mitral regurgitation group (45.7% vs no mitral regurgitation 64.7%, P = .0258) . Patients with mitral regurgitation had worse functional status (New York Heart Association class 3-4 20.0%, n = 30/150, vs no mitral regurgitation 8.1%, n = 25/307, P = .0046). After the matched variables were controlled for, the hazard ratios associated with the presence of mitral regurgitation by Cox regression were 0.958 (P = .7626) for survival and 1.198 (P = .0333) for event-free survival. The only other significant predictor of late survival was preoperative intra-aortic balloon pump insertion (hazard ratio 2.484, P = .0365). Of the patients who underwent follow-up echocardiography, 30.6% (n = 15/49) had progression of mitral regurgitation to moderate to severe degree at an average of 16.4 postoperative months.

CONCLUSION: Overall late survival was not affected by the presence of mild to moderate degrees of mitral regurgitation in patients undergoing coronary artery bypass grafting. However, these patients had poorer event-free survival and worse late functional status. In a subset of patients with echocardiographic follow-up, the postoperative course of mitral regurgitation was variable, and nearly a third of these patients had worsening mitral regurgitation. Consideration should be given to repairing moderate mitral regurgitation in selected cases to improve long-term quality of life.

This article has been cited by other articles:

				A. M. Calafiore, V. Mazzei, A. L. Iaco, M. Contini, A. Bivona, M. Gagliardi, P. Bosco, S. Gallina, and M. Di Mauro Impact of ischemic mitral regurgitation on long-term outcome of patients with ejection fraction above 0.30 undergoing first isolated myocardial revascularization. Ann. Thorac. Surg., August 1, 2008; 86(2): 458 - 464. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, A. L. Iaco, M. Contini, A. Bivona, E. Varone, P. Greco, and S. Scandura Mitral Valve Repair for Ischemic Mitral Regurgitation Angiology, August 1, 2008; 59(2_suppl): 89S - 92S. [Abstract] [PDF]

				B. A. Carabello The Current Therapy for Mitral Regurgitation J. Am. Coll. Cardiol., July 29, 2008; 52(5): 319 - 326. [Abstract] [Full Text] [PDF]

				T. D. Crabtree, M. S. Bailey, M. R. Moon, N. Munfakh, M. K. Pasque, J. S. Lawton, N. Moazami, K. A. Aubuchon, A. S. Al-Dadah, and R. J. Damiano Jr Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann. Thorac. Surg., May 1, 2008; 85(5): 1537 - 1542. [Abstract] [Full Text] [PDF]

				E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato Ischemic mitral regurgitation: mechanisms and echocardiographic classification Eur J Echocardiogr, March 1, 2008; 9(2): 207 - 221. [Abstract] [Full Text] [PDF]

				M. Di Donato, S. Castelvecchio, J. Brankovic, C. Santambrogio, V. Montericcio, and L. Menicanti Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1548 - 1553. [Abstract] [Full Text] [PDF]

				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]

				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]

				J. N. Schroder, M. L. Williams, J. A. Hata, L. H. Muhlbaier, M. Swaminathan, J. P. Mathew, D. D. Glower, C. M. O'Connor, P. K. Smith, and C. A. Milano Impact of Mitral Valve Regurgitation Evaluated by Intraoperative Transesophageal Echocardiography on Long-Term Outcomes After Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-293 - I-298. [Abstract] [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]

				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]

				P. Fundaro, P. Tartara, and E. Vitali Moderate mitral regurgitation repair at the time of coronary bypass: When is it required? J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 796 - 796. [Full Text] [PDF]

				H. R. Mallidi and M. P. Pelletier Reply J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 796 - 797. [Full Text] [PDF]