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J Thorac Cardiovasc Surg 2009;138:286-288
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

COUNTERPOINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation

Division of Cardiothoracic Surgery and Cardiology, Cedars–Sinai Medical Center, Los Angeles, Calif

Received for publication May 23, 2008; revisions received April 6, 2009; accepted for publication May 2, 2009.

^_* Address for reprints: Alfredo Trento, MD, Cedars–Sinai Medical Center, Cardio-Thoracic Surgery, 8700 Beverly Blvd, Suite 6215, Los Angeles, CA 90048. (Email: alfredo.trento@cshs.org).

The first 300 words of the full text of this article appear below.

	Introduction

 
Dr Fattouch and colleagues present the first prospective randomized trial on the very controversial group of patients with chronic moderate ischemic mitral regurgitation (MR) undergoing coronary artery bypass (CAB). They randomized 100 patients with 2+ ischemic MR to CAB alone and combined CAB plus restrictive mitral annuloplasty. All patients had a prior myocardial infarction (MI) and decreased ventricular function (ejection fraction [EF], 42%), New York Heart Association (NYHA) class was 2.3, left ventricular end-diastolic diameter (LVEDD) was 59 mm, and pulmonary artery pressure was 40 mm Hg. The 5-year survival was 88.8% in the CAB-only group and 93.7% in the combined group. The combined group showed reverse remodeling with resolution of MR at 5 years (mean MR grade, 0.08 ± 0.2; LVEDD, 52 mm; left ventricular [LV] EF, 48%; pulmonary artery pressure, 26 mm Hg; and mean NYHA class, 0.6). The CAB-only group showed an insignificant improvement in functional parameters and worsening of MR in 35%. Exercise echocardiographic analysis was basically normal in the combined group but significantly impaired in the CAB-only group. These results are impressive.

	Retrospective Studies

 
Previous publications have been retrospective studies that have important limitations even when statistical analysis of propensity-matched groups was used to compensate for the bias related to patient selection (Table 1 ).^1-6 One such study was published in the past year by the Cleveland Clinic group.¹ Mihaljevic and colleagues¹ reviewed 390 patients from 1991 to 2003 with 3+ or 4+ ischemic MR. Of these, 290 underwent CAB plus mitral valve (MV) annuloplasty, and 100 underwent CAB alone. Groups were propensity matched by using demographics, extent of coronary artery disease, regional wall motion, and quantitative echocardiographic analysis. The 1-, 5-, and 10-year survivals were 88%, 75%, and 47% after CAB alone and 92%, 74%, and 39% after CAB plus mitral annuloplasty. NYHA class improved . . . [Full Text of this Article]

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